[Effects of age on the response to Tilt test in patients with malaise or syncopes]

The diagnosis of vasovagal malaise or syncope, suspected from the clinical history, may be confirmed by the tilt test. The aim of this study was to assess the effects of age on the results of this test in 346 patients who had unexplained malaise or syncope. Thirty-one patients were 7 to 19 years of age (group I), 59 were 20 to 40 (group II), 72 were 41 to 60 (group III) and 184 were 61 to 85 years old (group IV). The patients were maintained in the dorsal decubitus position for 20 minutes and then raised to 70 degrees until a malaise was observed or for a maximum of 40 minutes. The malaise or syncope was reproduced by the tilt test in 135 cases (39%). The number of positive responses was comparable in group I, II, III and IV (45, 42, 32 and 40%, respectively). The time before the malaise occurred was also similar in the four groups (17, 19, 15 and 20 minutes, respectively). Two responses to the tilt test characterised the different age groups: the greater number of malaises occurring independently of a drop in blood pressure or change in heart rate ("psychiatric" syncope) in group II compared with groups I, III and IV (40% versus 7, 9 and 9.5%); the higher frequency of pure vasodepressive forms in group IV compared with groups I, II and III (66% versus 28.5, 32 and 39%). In conclusion, the probability of a positive tilt test does not change with age. The mechanisms of the symptoms produced is the only difference observed with age.