(Circulation. 1997;96:581-584.)
© 1997 American Heart Association, Inc.
Articles |
Prediction of Head-Up Tilt Test Result by Analysis of Early Heart Rate Variations
From the Centre de Rythmologie et de Stimulation Cardiaque (Z.M., A.S., J.V., G.F., R.F.), Hôpital Jean Rostand, Ivry-sur-Seine, and the Laboratory of Biophysics and INSERM (E.V.), Unité 141, Hôpital Fernand Widal, Paris, France.
Correspondence to Robert Frank, MD, Centre de Rythmologie et de Stimulation Cardiaque, Hôpital Jean Rostand, 39, rue Jean-le-Galleu, 94200 Ivry-sur-Seine, France.
Background Head-up tilt testing is a useful test for investigating vasovagal syncope. The determination of early, accurate, predictive criteria for a negative result would permit a reduction in the duration of the tilt test.
Methods and Results Patients with no drug use and no
illnesses other than recurrent unexplained syncope were recruited. In
an initial study (110 consecutive patients), we aimed to determine a
predictive criterion based on heart rate variations during the first
minutes of upright tilting that could distinguish between patients with
positive and negative tilt tests (patients with an early continual
decrease in heart rate or blood pressure were excluded). Then we tested
the predictive value of the established criterion in a second
independent sample of patients with unexplained syncope (109
consecutive patients). An early sustained increase in heart rate 
18
bpm during the first 6 minutes of upright tilting at a 60° angle
allowed us to predict negative tilt tests with 100% specificity, 100%
positive predictive value, and 88.6% sensitivity. This criterion was
validated in the second, prospective arm of the study (96.4%
specificity, 98.4% positive predictive value, and 87.3% sensitivity),
even with subsequent use of isoproterenol in low doses.
Conclusions In patients with no drug use and no illnesses other than recurrent unexplained syncope, a simple clinical criterion identifies patients who will not develop syncope during a prolonged upright tilt.
Key Words: isoproterenol • syncope • tests • heart rate
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