title: Nitrate-potentiated head-up tilt testing in older patients: outcomes, hemodynamic responses and prodrome recognition.
abstract: 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.
authors.affiliation: Cardiology Unit, Emergency and Organ Transplantation Department, University of Bari, Piazza Giulio Cesare 11, Bari, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Guida
authors.forename: Massimo
authors.initials: M
authors.lastname: Iacoviello
authors.forename: Cinzia
authors.initials: C
authors.lastname: Forleo
authors.forename: Sandro
authors.initials: S
authors.lastname: Sorrentino
authors.forename: Agata
authors.initials: A
authors.lastname: Puzzovivo
authors.forename: Marica
authors.initials: M
authors.lastname: Rodio
authors.forename: Francesca
authors.initials: F
authors.lastname: De Pascalis
authors.forename: Cataldo
authors.initials: C
authors.lastname: Balducci
authors.forename: Margherita
authors.initials: M
authors.lastname: Sarlo
authors.forename: Stefano
authors.initials: S
authors.lastname: Favale
mesh_terms: 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
chemical_list: D009566:Nitrates; D005996:Nitroglycerin