title: Clinical relevance of syncope and presyncope induced by tilt testing.
abstract: OBJECTIVE
  The authors investigated the relation between presyncope and syncope induced by tilt testing (HUTT) and demographics, medical history and HUTT data.The demographics, syncopal burden, data regarding the spontaneous syncope and reproduction of symptoms during HUTT were compared among patients with induced syncope and presyncope. The study group consisted of 574 patients (371 women, 203 men), aged 43.7 +/- 18.5 years.
  
  
  RESULTS
  Patients with syncope induced by HUTT (418 patients, 63.9% women) had a higher number of syncopal episodes in their medical history. Stepwise logistic regression revealed that syncope provocation was independently related to the cardiodepressive type of neurocardiogenic reaction (OR 7.8, CI 4.2-14.4, P < 0.001), NTG use (OR 1.7, CI: 1.0-2.7, P < 0.05), the reproduction of the symptoms during HUTT (OR 2.0, CI: 1.3-3.1, P < 0.01) and the higher number of syncopal episodes (OR 2.0, CI: 1.3-3.0, P < 0.01). In patients with positive HUTT during a passive phase it was related to the cardiodepressive type of reaction (OR 26.5, CI: 5.9-118.5, P < 0.001). In the group with positive HUTT after NTG syncope was related to the cardiodepressive type (OR 5.7, CI: 2.9-11.2, P < 0.001), vasovagal history (OR 2.0, CI: 1.2-3.3, P < 0.01), reproduction of the spontaneous symptoms (OR 1.9, CI: 1.1-3.1, P < 0.05) and higher number of syncopal episodes (OR 2.1, CI: 1.3-3.3, P < 0.01).
  
  
  CONCLUSIONS
  Syncope is more frequently a HUTT outcome than presyncope. The provocation of syncope in the passive phase of HUTT depends only on the cardiodepressive type of neurocardiogenic reaction. The induction of presyncope after nitroglycerin provocation is related to the possibility of a false positive reaction.
authors.affiliation: Teaching Department for Emergency Medical Services, Wroclaw Medical University, Poland. dzysko@wp.pl
authors.forename: Dorota
authors.initials: D
authors.lastname: Zyśko
authors.forename: Jacek
authors.initials: J
authors.lastname: Gajek
authors.forename: Edward
authors.initials: E
authors.lastname: Koźluk
authors.forename: Anil Kumar
authors.initials: AK
authors.lastname: Agrawal
authors.forename: Jacek
authors.initials: J
authors.lastname: Smereka
authors.forename: Igor
authors.initials: I
authors.lastname: Checiński
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010275:Parasympathetic Nervous System / Q000503:physiopathology*; D015203:Reproducibility of Results; D013575:Syncope / Q000175:diagnosis / Q000209:etiology*; D019462:Syncope, Vasovagal / Q000503:physiopathology; D018667:Tilt-Table Test