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Diagnostic Value of Test Tilt in Unexplained Syncope—A Heart Institute Abidjan

DOI: 10.4236/oalib.1102060    590 Downloads   803 Views  

ABSTRACT

Objective: To evaluate the diagnostic and prognostic contribution of tilt testing in the assessment of unexplained syncope. Patients and Methods: All patients who had a tilt test at Abidjan Heart Institute between October 2014 and May 2015 (a period of eight months) were included and followed in this study. During the monitoring period, patients were interviewed in consultation and examination room. Results: A tilt test was performed in 60 patients with mean age of 45 ± 20 years, with a sex ratio of a man for a woman referred to our service for exploration of unexplained syncope. The tilt in dorsal decubitus test was negative in all patients. In inclined position the test was positive in 10 patients (17%), and then in inclined position with instillation of glyceryl trinitrate the test was positive in 35 patients (58%). The tilt test was positive in 45 patients or 75%. The responses were observed vaso-depressive response in 22 patients, a mixed response in 8 patients, and cardio-inhibitory response in 15 patients. After three months follow-up, through lifestyle changes, through recognition of early symptoms, regular rehydration by the eviction of confined atmospheres, and the reduction of antihypertensive treatment, adoption of the dorsal decubitus or position sitting at the onset of symptoms, 95% of patients had not presented any recurrence of symptoms. The incidence of recurrence was the same regardless of the type of response to the tilt test. Conclusion: The tilt test is easily achievable but disregarded under review and used in our health centers. It has some diagnostic value in exploring the unexplained syncope. The syncope recurrence rate after a tilt test is very low.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Djinguin n’dri Ben Koffi, J. (2015) Diagnostic Value of Test Tilt in Unexplained Syncope—A Heart Institute Abidjan. Open Access Library Journal, 2, 1-5. doi: 10.4236/oalib.1102060.

References

[1] Blanc, J.J., L’Her, C., Touiza, A., et al. (2002) Prospective Evaluation and Out-Come of Patients Admitted for Syncope over a 1 Year Period. European Heart Journal, 23, 815-820.
http://dx.doi.org/10.1053/euhj.2001.2975
[2] Disertori, M., Brignole, M., Menozzi, C., et al. (2003) Management of Patients with Syncope Referred Urgently to General Hospitals. Europace, 5, 283-291.
http://dx.doi.org/10.1016/S1099-5129(03)00049-7
[3] Sheldon, R., Rose, S., Flanagan, P., Koshman, M.L. and Killiam, S. (1996) Risk Factors for Syncope Recurrence after a Positive Tilt-Test in Patients with Syncope. Circulation, 93, 973-981.
http://dx.doi.org/10.1161/01.CIR.93.5.973
[4] Njoo, Z., Alizadeh, A., Alasti, M., Fadaie, A.A., Haghjoo, M., Fazelifar, A.F., et al. (2007) Correlation between Results of Head-Up Tilt Test and Clinical Features in Patients with Syncope or Presyncope. Journal of Electrocardiology, 40, 200-202.
http://dx.doi.org/10.1016/j.jelectrocard.2006.07.006
[5] Kouakam, C. (2011) Test d’inclinaison Modalités, techniques et résultats. Elservier Masson SAS, EMC.
[6] Moya, A., Sutton, R., Ammirati, F., Blanc, J.J., Brignole, M., Dahm, J.B., et al. (2009) Guideline for the Diagnosis and Management of Syncope (Version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiogy (ESC). European Heart Journal, 30, 2631-2671.
http://dx.doi.org/10.1093/eurheartj/ehp298
[7] Linzer, M., Yang, E.H., Estes III, N.A., et al. (1997) Diagnosing Syncope. Part II: Unexplained Syncope. Clinical Efficacy Assessment Project of the American College of Physicians. Annals of Internal Medicine, 127, 1352-1355.
http://dx.doi.org/10.7326/0003-4819-127-1-199707010-00014
[8] Macebo, P.G., Asirvatham, S.J., Maia, L., Ferreira Neto, E., Zanatta, A., Sobral Neto, J., et al. (2012) Comparison of a Shortened Isosorbide Dinitrate-Potentiated Head-Up Tilt Test Testing with the Conventional Protocol: Tolerance and Diagnostic Accuracy. Pacing and Clinical Electrophysiology, 35, 1005-1011.
http://dx.doi.org/10.1111/j.1540-8159.2012.03440.x
[9] Khan, H.F., Hameed, M.A. and Khan, U.A. (2010) Short Duration Head-Up Tilt Test: A Comparison with Conventional Long Protocol in Patients of Orthostatic Ontolerance. Annals of Noninvasive Electrocardiology, 15, 101-106.
[10] Exposito, V., Guzman, J.C., Orava, M., Armaganijan, L. and Morillo, C.A. (2013) Usefulness of the Calgary Syncope Symptom Score for the Diagnosis of Vasovagal Syncope in the Elderly. Placing Clinical Electrophysiol, 36, 37-41.
http://dx.doi.org/10.1093/europace/eut042
[11] Moya, A., Permanyer-Miralda, G., Sagrista-Sauleda, J., et al. (1955) Limitations of Head-Up Tilt Test for Evaluating the Efficacity of Therapeutic Interventions in Patients with Vaso-Vagal Syncope; Results of a Controlled Study of Etilefrine versus Placebo. Journal of the American College of Cardiology, 25, 65-69.
http://dx.doi.org/10.1016/0735-1097(94)00336-O
[12] Petersen, R. (1995) The Clinical Spectrum of Neurocardiogenic Syncope. Journal of Cardiovascular Electrophysiology, 6, 54-58.
[13] Kenny, R.A., Ingram, A., Bayliss, J. and Sutton, R. (1986) Head-Up Tilt: A Useful Test for Investigating Unexplained Syncope. Lancet, 1, 1352-1355.
http://dx.doi.org/10.1016/S0140-6736(86)91665-X
[14] Domenichini, G., Diemberger, I., Biffi, M., Martignani, C., Valzania, C., Bertini, M., et al. (2010) Long-Term Follow-Up of Patients with Syncope Evaluated by Head-Up Tilt Test. Annals of Noninvasive Electrocardiology, 15, 101-106.
http://dx.doi.org/10.1111/j.1542-474X.2010.00349.x

  
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