Head-up tilt test diagnostic yield in syncope diagnosis

Area of Science:

• Cardiology
• Neurology
• Clinical Medicine

Background:

• The European Syncope Guidelines (ESG) suggest Head-up tilt test (HUT) for suspected vasovagal syncope (VVS) or orthostatic hypotensive syncope (OHS) after initial evaluations.
• This study reports single-center experience with HUT in patients with suspected VVS or OHS, following exclusion of high-risk cardiac causes.

Purpose of the Study:

• To evaluate the effectiveness of HUT in diagnosing VVS and OHS in a Syncope Clinic setting.
• To assess adherence to ESG recommendations and the impact on diagnostic test utilization.

Main Methods:

• Prospective consecutive inclusion of 1058 syncopal patients referred for HUT.
• Pre-classification of patients into VVS, OHS, or Syncope of Unknown Etiology (SUE) based on ESG criteria.
• Review of clinical history and prior diagnostic tests before HUT.

Main Results:

• HUT was positive in 57.5% of patients (609/1058).
• Positive HUT rates varied by pre-classification: 60% for VVS, 46.1% for OHS, and 54.3% for SUE (p=0.037).
• Combined ESG and HUT yielded diagnoses: 72% VVS, 8.4% OHS, and 19.5% SUE.

Conclusions:

• Appropriate application of ESG recommendations with HUT identified 81% of patients with non-cardiogenic syncope.
• This integrated approach potentially avoids a significant number of unnecessary diagnostic tests.