Nitrate-potentiated head-up tilt testing in older patients: outcomes, hemodynamic responses and prodrome recognition.
BACKGROUND
To compare head-up tilt testing (HUT) outcomes and hemodynamic responses, and the prevalence and correlates of prodromes, in elderly and younger patients with suspected vasovagal syncope (VVS).


METHODS
Consecutive outpatients with a history of recurrent unexplained syncope underwent HUT by being tilted to 70°; the test was potentiated by the administration of 300 μg of nitroglycerine after 20 minutes. Occurrence of VVS and hemodynamic responses during passive and nitroglycerine phases of HUT were evaluated; symptoms preceding HUT-induced syncope were recorded, together with heart rate and arterial blood pressure values.


RESULTS
Four hundred and sixty of the 743 patients were HUT positive: 156 fainted during the unmedicated phase and 304 after nitroglycerine administration. The patients aged ≥65 years (n = 102) experienced VVS more frequently during the pharmacological stage of HUT; the overall rate of positive results was similar to that observed in the patients aged 36-64 years (n = 329) and only slightly lower than that observed in those aged ≤ 35 years (n = 312). In the older patients, who experienced fewer and mainly prodrome-free spontaneous syncopal episodes, HUT increased the number of premonitory symptoms, and there were no significant age-related differences in symptom prevalence or timing or the patients' hemodynamic characteristics.


CONCLUSIONS
The rate of VVS induced by nitroglycerine-potentiated HUT is similar in elderly and younger patients. In the former, nitroglycerine-potentiated HUT significantly increases the prevalence of prodromes in comparison with spontaneous episodes, which suggests that it may be useful not only for diagnosis but also for patient counseling.
Guida
Pietro
P
Cardiology Unit, Emergency and Organ Transplantation Department, University of Bari, Piazza Giulio Cesare 11, Bari, Italy.
Iacoviello
Massimo
M
Forleo
Cinzia
C
Sorrentino
Sandro
S
Puzzovivo
Agata
A
Rodio
Marica
M
De Pascalis
Francesca
F
Balducci
Cataldo
C
Sarlo
Margherita
M
Favale
Stefano
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009566:Nitrates / Q000494:pharmacology*; D005996:Nitroglycerin; D015995:Prevalence; D019462:Syncope, Vasovagal / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D018667:Tilt-Table Test / Q000379:methods*; D055815:Young Adult
D009566:Nitrates; D005996:Nitroglycerin