Short pain-provoked head-up tilt test for the confirmation of vasovagal syncope.
We investigated a short pain-provoked head-up tilt (PP-HUT) and the Calgary Syncope Symptom Score in a group of patients with clinically diagnosed vasovagal syncope and group of neurological patients without transient loss of consciousness. We included 127 consecutive patients who were investigated in our laboratory. The group 1 included 56 patients who after appropriate investigations were diagnosed with vasovagal syncope. The group 2 included 70 neurological patients without transient loss of consciousness. The subjects were tilted to 70° for a maximum period of 10 min or until symptoms occurred. If there were no symptoms after initial 10 min, a painful stimulus with the insertion of 0.7 mm needle into the dorsum of hand subcutaneously for 30 s was performed with the patient in the tilted for further 5 min. Calgary Syncope Symptom Score was calculated for all patients. In the group 1, significantly higher number of patients had positive results on PP-HUT (36 vs. 6 patients, respectively; p < 0,001). There was no difference in the presence of orthostatic hypotension (8 vs. 15 patients, respectively; p = 0.36) or postural orthostatic tachycardia syndrome (3 vs. 1 patient, respectively; p = 0.32) between groups. PP-HUT had sensitivity of 65.9 % (95 % CI 0.49-0.79) and specificity of 89.7 % (95 % CI 0.75-0.97). The CSSS had sensitivity of 58.5 % (95 % CI 0.42-0.73) and specificity of 46.1 % (95 % CI 0.30-0.63). PP-HUT has a higher diagnostic rate than the CSSS and provides a rapid alternative to conventional methods.
University Department of Neurology, Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia.
Ivan
I
Adamec
Antonija
A
Mišmaš
Dinka
D
Zaper
Anamari
A
Junaković
Sanja
S
Hajnšek
Mario
M
Habek
D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006257:Head; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology*; D011187:Posture / Q000502:physiology*; D019462:Syncope, Vasovagal / Q000145:classification / Q000175:diagnosis*; D018667:Tilt-Table Test / Q000379:methods*; D055815:Young Adult