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Updated: Apr 27, 2026
Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance
Published on: March 21, 2013
Different haemodynamic patterns in head-up tilt test on 400 paediatric cases with unexplained syncope
Yilmaz Yozgat1, Cem Karadeniz1, Rahmi Ozdemir1
1Department of Pediatric Cardiology,Dr. Behcet Uz Children's Hospital,Izmir,Turkey.
Insights
Head-up tilt testing identified nine distinct hemodynamic patterns in 400 children with unexplained syncope. This study highlights the need for further research into orthostatic intolerance syndromes affecting children.
Area of Science:
- Pediatric Cardiology
- Autonomic Nervous System Function
- Diagnostic Testing
Background:
- Unexplained syncope is a common reason for pediatric referrals.
- Head-up tilt testing (HUTT) is a key diagnostic tool for evaluating syncope.
- Understanding hemodynamic patterns in pediatric syncope is crucial for effective management.
Purpose of the Study:
- To characterize the diverse hemodynamic response patterns observed during head-up tilt testing in a large cohort of children with unexplained syncope.
- To identify the prevalence of different syncope subtypes based on HUTT findings.
Main Methods:
- Retrospective analysis of 400 pediatric patients (aged 5-18 years) diagnosed with unexplained syncope.
- Standardized head-up tilt testing protocol involving 25 minutes supine rest and 20 minutes of 70° upright tilt.
- Classification of patients into nine distinct hemodynamic pattern groups based on their response to tilt testing.
Main Results:
- The majority of patients (69.2%) had negative HUTT results.
- Specific diagnoses included vasovagal syncope (9.5%), orthostatic intolerance (7.0%), and postural orthostatic tachycardia syndrome (POTS) (6.0%).
- Various subtypes of vasovagal syncope and POTS were identified, indicating heterogeneous responses.
Conclusions:
- Head-up tilt testing reveals at least nine distinct hemodynamic patterns in children with unexplained syncope.
- Orthostatic intolerance syndromes are significant contributors to pediatric syncope, impacting daily activities.
- Further clinical investigation is warranted to improve the diagnosis and management of these conditions in pediatric populations.
Objective:
To assess haemodynamic patterns in head-up tilt testing on 400 paediatric cases with unexplained syncope.
Methods:
Medical records of 520 children who underwent head-up tilt testing in the preceding year were retrospectively evaluated, and 400 children, 264 (66%) girls and 136 (34%) boys, aged 12.6±2.6 years (median 13; range 5-18), with unexplained syncope were enrolled in the study. Age, sex, baseline heart rate, baseline blood pressure, frequency of symptoms, and/or fainting attacks were recorded. The test protocol consisted of 25 minutes of supine resting followed by 20 minutes of 70° upright positioning. Subjects were divided into nine groups according to their differing haemodynamic patterns.
Results:
There were no statistically significant differences between the groups with regard to age, gender, baseline blood pressure, and frequency of syncope (p>0.05). The response was compatible with orthostatic intolerance in 28 cases (7.0%), postural orthostatic tachycardia syndrome in 24 cases (6.0%), asymptomatic postural orthostatic tachycardia syndrome in 26 cases (6.5%), orthostatic hypotension in seven cases (1.7%), vasovagal syncope in 38 cases (9.5%), and negative in 274 cases (69.2%). Vasovagal syncope response patterns were of type 3 in nine cases (2.2%), type 2A in 10 cases (2.5%), type 2B in two cases (0.5%), and type 1 (mixed) in 17 cases (4.25%).
Conclusions:
In the 400 paediatric cases with unexplained syncope, nine different haemodynamic response patterns to head-up tilt testing were discerned. Children with orthostatic intolerance syndromes are increasingly referred to hospitals because of difficulty in daily activities. Therefore, there is need for further clinical trials in these patient groups.
