RT-33
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Sensitivity and specificity of
head-up tilt testing with orciprenaline
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Sven Reek, Daniela Polywka,
Helmut U. Klein.
Department of Cardiology, University Hospital Magdeburg, Magdeburg, Germany
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Abstract
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Purpose. The ideal protocol for
head-up tilt testing is still a matter of debate. Head-up tilt testing with low-dose
isoprenaline has an acceptable high sensitivity and specificity. The purpose of our study
was to evaluate the sensitivity and specificity of head-up tilt testing using
orciprenaline.
Methods. Head-up tilt testing was performed in 24 patients (11 male,
13 female, mean age 35.9 years) with > 1 syncope and in 30 healthy volunteers (18 male,
12 female, mean age 26 years) without any history of syncope. Subjects were tilted 70
degrees for 45 min at baseline. Then orciprenaline infusion was titrated to achieve a 30%
increase in heart rate. A second head-up tilt testing was performed for 15 minutes
thereafter with a pause of 15 minutes in between both tests. Electrocardiogram was
recorded and blood pressure was continuously measured noninvasively. A positive head-up
tilt test was defined as a decrease of blood pressure of > 30 mmHg or a drop in heart
rate of > 30 bpm combined with syncope or presyncope.
Results. Eight (33%) of 24 patients with a history of syncope had
positive baseline head-up tilt testings, another 9 patients (38%) had positive head-up
tilt testings with orciprenaline and in 7 patients (29%) we found a negative result at
baseline testing as well as with orciprenaline. The sensitivity of the complete protocol
for patients with > 1 syncope was 71%. There was only one of 30 volunteers (3%) who had
a positive result at baseline testing. Two additional volunteers had positive head-up tilt
testings with orciprenaline. The specificity of our baseline head-up tilt testing was 97
and 90% with orciprenaline respectively.
Conclusion. Adding orciprenaline as an additional part of head-up
tilt testing has an acceptable high sensitivity and a good specificity in the evaluation
of patients with neurocardiogenic syncope. Our results are comparable to protocols using
low-dose isoprenaline.
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Key Words
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Syncope
head-up tilt testing, orciprenaline, OA
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