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Updated: Aug 15, 2026

Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance
Published on: March 21, 2013
Multidisciplinary approach for diagnosing syncope: a retrospective study on 521 outpatients
S Strano1, C Colosimo, A Sparagna
1Cardiovascular Pathophysiology, University of Rome La Sapienza, 00161 Rome, Italy. stefano.strano@uniroma1.it
Neurally mediated syncope is the most common cause of fainting. Autonomic nervous system (ANS) evaluation, including tilt testing, is crucial for diagnosing syncope when heart issues are absent.
Area of Science:
- Cardiology
- Neurology
- Autonomic Nervous System Disorders
Background:
- Syncope diagnosis can be challenging, particularly when structural heart disease is ruled out.
- A multidisciplinary approach in syncope units aids in diagnosing unexplained syncope.
Purpose of the Study:
- To identify causes of syncope in outpatients without structural heart disease.
- To evaluate the effectiveness of a syncope unit's multidisciplinary approach.
Main Methods:
- 521 outpatients underwent extensive cardiovascular autonomic nervous system (ANS) function evaluation.
- Methods included history, physical exam, orthostatic blood pressure, ECG, and tilt testing.
Main Results:
- Syncope causes remained unknown in 29.2% of cases.
- ANS dysfunction was identified in 58.6% of patients, primarily neurally mediated syncope (53.6%).
- 3.8% had cardiogenic syncope or non-neurogenic hypotension; 8.4% had non-syncopal causes.
Conclusions:
- Neurally mediated syncope is the most frequent type.
- ANS evaluation with tilt testing is recommended for syncope without heart abnormalities.
- Consider ANS failure in patients with atypical seizures.
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