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(Circulation. 2002;105:146.)
© 2002 American Heart Association, Inc.

Brief Rapid Communications

Shortened Head-Up Tilting Test Guided by Systolic Pressure Reductions in Neurocardiogenic Syncope

Mariavittoria Pitzalis, MD PhD; Francesco Massari, MD; Pietro Guida, MS; Massimo Iacoviello, MD; Filippo Mastropasqua, MD; Brian Rizzon, MD; Cinzia Forleo, MD; Paolo Rizzon, MD

From the Institute of Cardiology (M.P., P.G., M.I., B.R., C.F., P.R.) and Innovative Technologies for Signal Detection and Processing Center (M.P., P.R.), University of Bari, Bari; and the Cardiology Department, "Maugeri" Foundation (F. Massari, F. Mastropasqua), Cassano, Italy.

Correspondence to Mariavittoria Pitzalis, MD, PhD, Institute of Cardiology, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy. E-mail mariavittoria.pitzalis{at}cardio.uniba.it

Background— Asymptomatic reductions in arterial pressure have been reported to occur before the onset of tilt-induced syncope. We investigated the predictive value of these reductions for a positive tilt result.

Methods and Results— In a first study, 238 consecutive healthy subjects with unexplained syncope underwent a passive tilt table test. Finger systolic arterial pressure (SAP) recordings made it possible to calculate how many of the beat-to-beat SAP values during the first 15 minutes of tilt were lower than the lowest value recorded at baseline. Neurocardiogenic syncope was diagnosed in 73 subjects; 28 fainted after 15 minutes of tilt and experienced more pressure reductions than did the subjects with a negative test (328±400 versus 119±284; P<0.01). More than 14 SAP reductions during the first 15 minutes of tilt allowed us to predict a positive test with 93% sensitivity, 58% specificity, and positive and negative predictive values of 28% and 98%, respectively. In a second prospective study (80 consecutive subjects), the online analysis of this criterion by visually inspecting a Finapres monitor showed 80% sensitivity, 85% specificity, and positive and negative predictive values of 57% and 94%.

Conclusions— In healthy subjects with unexplained syncope, the evaluation of SAP reductions during the first 15 minutes of tilt is a marker of systolic pressure instability preceding syncope and constitutes a simple and good predictor of tilt outcome that could be used to guide test duration.

Key Words: blood pressure • syncope • cost-benefit analysis

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