Background: Syncope is a relevant health problem in military environments. Reliable diagnosis is challenging. Tilt table testing is an important tool for syncope diagnosis. The aim of this study was to determine wheth...Background: Syncope is a relevant health problem in military environments. Reliable diagnosis is challenging. Tilt table testing is an important tool for syncope diagnosis. The aim of this study was to determine whether signs such as prodromal symptoms, co-morbidity, frequency of syncopal events, body length, body mass index, and electrocardiography(ECG) abnormalities can be used to predict the success of tilt table testing at diagnosing syncope.Methods: Data from 100 patients with histories of syncope or pre-syncope, who were diagnosed using head-up tilt table testing, were retrospectively analyzed in a cross-sectional analysis. The diagnostic procedure was based upon a modified version of the Westminster protocol without any pharmacological provocation. Results: Patients showing pathological reaction patterns during tilt table testing suffered from prodromal symptoms, such as dizziness and sweating, significantly more often. The patients reported more injuries resulting from syncopal events and more previous syncopal events, and the prevalence of co-morbidity was greater among patients presenting negative findings during tilt testing. An asthenic-leptosomal physique was not confirmed as a risk factor for syncopal events as is the case for idiopathic arterial hypotension. However, patients with pathological reaction patterns during tilt table testing were significantly taller. This finding was detected for both females and males. No significant predictors were found in the ECG patterns of patients showing syncope during tilt table testing.Conclusions: Frequency of prior syncope and prodromal symptoms, and increased body length with an otherwise good state of health influence the predictive value of tilt table testing for syncope diagnosis. In particular, if these factors are present, tilt table testing should be considered part of the diagnostic algorithm for soldiers with recurrent syncope.展开更多
Background:Syncope is a relevant health problem in military environments.Reliable diagnosis is challenging.Tilt table testing is an important tool for syncope diagnosis.The aim of this study was to determine whether s...Background:Syncope is a relevant health problem in military environments.Reliable diagnosis is challenging.Tilt table testing is an important tool for syncope diagnosis.The aim of this study was to determine whether signs such as prodromal symptoms,co-morbidity,frequency of syncopal events,body length,body mass index,and electrocardiography abnormalities can be used to predict the success of tilt table testing at diagnosing syncope.Methods:Data from 100 patients with histories of syncope or pre-syncope,who were diagnosed using head-up tilt table testing,were retrospectively analyzed in a cross-sectional analysis.The diagnostic procedure was based upon a modified version of the Westminster protocol without any pharmacological provocation.Results:Patients showing pathological reaction patterns during tilt table testing suffered from prodromal symptoms,such as dizziness and sweating,significantly more often.The patients reported more injuries resulting from syncopal events and more previous syncopal events,and the prevalence of co-morbidity was greater among patients presenting negative findings during tilt testing.An asthenic-leptosomal physique was not confirmed as a risk factor for syncopal events as is the case for idiopathic arterial hypotension.However,patients with pathological reaction patterns during tilt table testing were significantly taller.This finding was detected for both females and males.No significant predictors were found in the electrocardiogram patterns of patients showing syncope during tilt table testing.Conclusions:Frequency of prior syncope and prodromal symptoms,and increased body length with an otherwise good state of health influence the predictive value of tilt table testing for syncope diagnosis.In particular,if these factors are present,tilt table testing should be considered part of the diagnostic algorithm for soldiers with recurrent syncope.展开更多
To investigate age and sex distribution of vasovagal syncope （VVS） patients undergoing head-up tilt table test （HUTT） at a tertiary hospital. The details of syncope patients who underwent HUTT at our department of...To investigate age and sex distribution of vasovagal syncope （VVS） patients undergoing head-up tilt table test （HUTT） at a tertiary hospital. The details of syncope patients who underwent HUTT at our department of cardiac function from January 2004 to December 2010 were reviewed. Of the 1 799 patients who underwent the HUTT, 854 tested positive, of which 558 （65.3%） were women, which were more than the women in the negative group （450, 47.6%） （p〈0.05）. VVS patients showed a bimodal age distribution between 11 and 20 years of age and in the fourth decade. In almost all age groups, mixed response was the highest compared with vasodepressor and cardioinhibitory. VVS patients who underwent HUTT indicate bimodal distribution peaking before the second decade and the fourth decade. The incidence of females was twice that of males before the sixth decade, and old age occupies a small percentage of VVS with no other comorbidities.展开更多
A tilt table test(TTT) is an inexpensive, noninvasive tool for the differential diagnosis of syncope and orthostatic intolerance and has good diagnostic yield. The autonomic system malfunction which underlines the ref...A tilt table test(TTT) is an inexpensive, noninvasive tool for the differential diagnosis of syncope and orthostatic intolerance and has good diagnostic yield. The autonomic system malfunction which underlines the reflex syncope is manifested as either hypotension or bradycardia, while an orthostatic challenge is applied. The timing of the response to the orthostatic challenge, as well as the predominant component of the response help to differentiate between various forms of neurocardiogenic syncope, orthostatic hypotension and non-cardiovascular conditions(e.g., pseudosyncope). Medications, such as isoproterenol and nitrates, may increase TTT sensitivity. Sublingual nitrates are easiest to administer without the need of venous access. TTT can be combined with carotid sinus massage to evaluate carotid sinus hypersensitivity, which may not be present in supine position. TTT is not useful to access the response to treatment. Recently, implantable loop recorders(ILR) have been used to document cardioinhibitory reflex syncope, because pacemakers are beneficial in many of these patients, especially those over 45 years of age. The stepwise use of both TTT and ILR is a promising approach in these patients. Recently, TTT has been used for indications other than syncope, such as assessment of autonomic function in Parkinson's disease and its differentiation from multiple system atrophy.展开更多
This study was to investigate the changes of autonomic nerve function and hemodynamics in patients with vasovagal syncope(VVS) during head-up tilt-table testing(HUT). HUT was performed in 68 patients with unexplained ...This study was to investigate the changes of autonomic nerve function and hemodynamics in patients with vasovagal syncope(VVS) during head-up tilt-table testing(HUT). HUT was performed in 68 patients with unexplained syncope and 18 healthy subjects served as control group. According to whether bradycardia, hypotension or both took place during the onset of syncope, the patients were divided during the test into three subgroups: vasodepressor syncope(VD), cardioinhibitory syncope(CI) and mixed syncope(MX) subgroups. Heart rate, blood pressure, heart rate variability(HRV), and deceleration capacity(DC) were continuously analyzed during HUT. For all the subjects with positive responses, the normalized low frequency(LFn) and the LF/HF ratio markedly decreased whereas normalized high frequency(HFn) increased when syncope occurred. Syncopal period also caused more significant increase in the power of the DC in positive groups. These changes were more exaggerated compared to controls. All the patients were indicative of a sympathetic surge in the presence of withdrawal vagal activity before syncope and a sympathetic inhibition with a vagal predominance at the syncopal stage by the frequency-domain analysis of HRV. With the measurements of DC, a decreased vagal tone before syncope stage and a vagal activation at the syncopal stage were observed. The vagal tone was higher in subjects showing cardioinhibitory responses at the syncopal stage. DC may provide an alternative method to understand the autonomic profile of VVS patients.展开更多
[SUMMARY] TTTT is a non-invasive and new investigative examination,and a most important method of clinical diagnosis for many diseases,specially for orthostatic syncope,autonomic failure,intracranial hypertension,neur...[SUMMARY] TTTT is a non-invasive and new investigative examination,and a most important method of clinical diagnosis for many diseases,specially for orthostatic syncope,autonomic failure,intracranial hypertension,neurodegenerative diseases,CVAs and so on.At the same time,TCD technique for non-invasive monitoring of CBFV has also provided a new tool for investigating CA.In clinical circumstance,we may carry on assessment of dynamic CA by TTTT,and this kind of method has been proved to be appropriate to examine patients and monitor.we can choose different tilt positions by tilt-table according to the different demands for clinical diagnosis or researches,and record the different appearances of various index signs,we can take advantage of the technique of transfer function analysis of power spectrum between spontaneous changes in CBF and other factors(such as arterial pressure) to do research on the specific mechanism of impaired CA.展开更多
To study the role of autonomic nervous system in the period of developing syncope induced by head-up tilt test(HUT), we analysed the changes of heart rate power spectral density(HRPSD) in 50 patients with unexplained ...To study the role of autonomic nervous system in the period of developing syncope induced by head-up tilt test(HUT), we analysed the changes of heart rate power spectral density(HRPSD) in 50 patients with unexplained syncope, including 15 positive patients (Group 1) and 35 negative patients(Group 2), and 15 negative healthy persons(Group 3) in 5 minute periods before and after tilting and 5 minutes before the end of test. HRPSD and their changes in total(T), very low-frequence(VLF), low-frequence(LF), high-frequence(HF) and the ratio of low/high frequence(LF/HF) were similar (P>0.05) 5 minutes before and after tilting among three groups. Five minutes before the end of test, Group 1 had obvious increase of T, VLF, LF and LF/HF while Group 2 and 3 had not such significant changes. There was significant difference(P<0.01) compared Group 1 with Group 2, 3. The results showed that the abnormal regulatory function of autonomic nervous system played an important role in the mechanism of symcope induced by HUT, the positive group had abnormal increase of sympathetic tone and imbalance of sympathetic/parasympathetic neural tone before syncope appeared.展开更多
文摘Background: Syncope is a relevant health problem in military environments. Reliable diagnosis is challenging. Tilt table testing is an important tool for syncope diagnosis. The aim of this study was to determine whether signs such as prodromal symptoms, co-morbidity, frequency of syncopal events, body length, body mass index, and electrocardiography(ECG) abnormalities can be used to predict the success of tilt table testing at diagnosing syncope.Methods: Data from 100 patients with histories of syncope or pre-syncope, who were diagnosed using head-up tilt table testing, were retrospectively analyzed in a cross-sectional analysis. The diagnostic procedure was based upon a modified version of the Westminster protocol without any pharmacological provocation. Results: Patients showing pathological reaction patterns during tilt table testing suffered from prodromal symptoms, such as dizziness and sweating, significantly more often. The patients reported more injuries resulting from syncopal events and more previous syncopal events, and the prevalence of co-morbidity was greater among patients presenting negative findings during tilt testing. An asthenic-leptosomal physique was not confirmed as a risk factor for syncopal events as is the case for idiopathic arterial hypotension. However, patients with pathological reaction patterns during tilt table testing were significantly taller. This finding was detected for both females and males. No significant predictors were found in the ECG patterns of patients showing syncope during tilt table testing.Conclusions: Frequency of prior syncope and prodromal symptoms, and increased body length with an otherwise good state of health influence the predictive value of tilt table testing for syncope diagnosis. In particular, if these factors are present, tilt table testing should be considered part of the diagnostic algorithm for soldiers with recurrent syncope.
文摘Background:Syncope is a relevant health problem in military environments.Reliable diagnosis is challenging.Tilt table testing is an important tool for syncope diagnosis.The aim of this study was to determine whether signs such as prodromal symptoms,co-morbidity,frequency of syncopal events,body length,body mass index,and electrocardiography abnormalities can be used to predict the success of tilt table testing at diagnosing syncope.Methods:Data from 100 patients with histories of syncope or pre-syncope,who were diagnosed using head-up tilt table testing,were retrospectively analyzed in a cross-sectional analysis.The diagnostic procedure was based upon a modified version of the Westminster protocol without any pharmacological provocation.Results:Patients showing pathological reaction patterns during tilt table testing suffered from prodromal symptoms,such as dizziness and sweating,significantly more often.The patients reported more injuries resulting from syncopal events and more previous syncopal events,and the prevalence of co-morbidity was greater among patients presenting negative findings during tilt testing.An asthenic-leptosomal physique was not confirmed as a risk factor for syncopal events as is the case for idiopathic arterial hypotension.However,patients with pathological reaction patterns during tilt table testing were significantly taller.This finding was detected for both females and males.No significant predictors were found in the electrocardiogram patterns of patients showing syncope during tilt table testing.Conclusions:Frequency of prior syncope and prodromal symptoms,and increased body length with an otherwise good state of health influence the predictive value of tilt table testing for syncope diagnosis.In particular,if these factors are present,tilt table testing should be considered part of the diagnostic algorithm for soldiers with recurrent syncope.
基金Supported by the National Natural Science Foundation of China (30972954)
文摘To investigate age and sex distribution of vasovagal syncope （VVS） patients undergoing head-up tilt table test （HUTT） at a tertiary hospital. The details of syncope patients who underwent HUTT at our department of cardiac function from January 2004 to December 2010 were reviewed. Of the 1 799 patients who underwent the HUTT, 854 tested positive, of which 558 （65.3%） were women, which were more than the women in the negative group （450, 47.6%） （p〈0.05）. VVS patients showed a bimodal age distribution between 11 and 20 years of age and in the fourth decade. In almost all age groups, mixed response was the highest compared with vasodepressor and cardioinhibitory. VVS patients who underwent HUTT indicate bimodal distribution peaking before the second decade and the fourth decade. The incidence of females was twice that of males before the sixth decade, and old age occupies a small percentage of VVS with no other comorbidities.
文摘A tilt table test(TTT) is an inexpensive, noninvasive tool for the differential diagnosis of syncope and orthostatic intolerance and has good diagnostic yield. The autonomic system malfunction which underlines the reflex syncope is manifested as either hypotension or bradycardia, while an orthostatic challenge is applied. The timing of the response to the orthostatic challenge, as well as the predominant component of the response help to differentiate between various forms of neurocardiogenic syncope, orthostatic hypotension and non-cardiovascular conditions(e.g., pseudosyncope). Medications, such as isoproterenol and nitrates, may increase TTT sensitivity. Sublingual nitrates are easiest to administer without the need of venous access. TTT can be combined with carotid sinus massage to evaluate carotid sinus hypersensitivity, which may not be present in supine position. TTT is not useful to access the response to treatment. Recently, implantable loop recorders(ILR) have been used to document cardioinhibitory reflex syncope, because pacemakers are beneficial in many of these patients, especially those over 45 years of age. The stepwise use of both TTT and ILR is a promising approach in these patients. Recently, TTT has been used for indications other than syncope, such as assessment of autonomic function in Parkinson's disease and its differentiation from multiple system atrophy.
基金supported by a grant from the Wuhan Science and Technology Program of China(No.2014060101010032)
文摘This study was to investigate the changes of autonomic nerve function and hemodynamics in patients with vasovagal syncope(VVS) during head-up tilt-table testing(HUT). HUT was performed in 68 patients with unexplained syncope and 18 healthy subjects served as control group. According to whether bradycardia, hypotension or both took place during the onset of syncope, the patients were divided during the test into three subgroups: vasodepressor syncope(VD), cardioinhibitory syncope(CI) and mixed syncope(MX) subgroups. Heart rate, blood pressure, heart rate variability(HRV), and deceleration capacity(DC) were continuously analyzed during HUT. For all the subjects with positive responses, the normalized low frequency(LFn) and the LF/HF ratio markedly decreased whereas normalized high frequency(HFn) increased when syncope occurred. Syncopal period also caused more significant increase in the power of the DC in positive groups. These changes were more exaggerated compared to controls. All the patients were indicative of a sympathetic surge in the presence of withdrawal vagal activity before syncope and a sympathetic inhibition with a vagal predominance at the syncopal stage by the frequency-domain analysis of HRV. With the measurements of DC, a decreased vagal tone before syncope stage and a vagal activation at the syncopal stage were observed. The vagal tone was higher in subjects showing cardioinhibitory responses at the syncopal stage. DC may provide an alternative method to understand the autonomic profile of VVS patients.
文摘[SUMMARY] TTTT is a non-invasive and new investigative examination,and a most important method of clinical diagnosis for many diseases,specially for orthostatic syncope,autonomic failure,intracranial hypertension,neurodegenerative diseases,CVAs and so on.At the same time,TCD technique for non-invasive monitoring of CBFV has also provided a new tool for investigating CA.In clinical circumstance,we may carry on assessment of dynamic CA by TTTT,and this kind of method has been proved to be appropriate to examine patients and monitor.we can choose different tilt positions by tilt-table according to the different demands for clinical diagnosis or researches,and record the different appearances of various index signs,we can take advantage of the technique of transfer function analysis of power spectrum between spontaneous changes in CBF and other factors(such as arterial pressure) to do research on the specific mechanism of impaired CA.
文摘To study the role of autonomic nervous system in the period of developing syncope induced by head-up tilt test(HUT), we analysed the changes of heart rate power spectral density(HRPSD) in 50 patients with unexplained syncope, including 15 positive patients (Group 1) and 35 negative patients(Group 2), and 15 negative healthy persons(Group 3) in 5 minute periods before and after tilting and 5 minutes before the end of test. HRPSD and their changes in total(T), very low-frequence(VLF), low-frequence(LF), high-frequence(HF) and the ratio of low/high frequence(LF/HF) were similar (P>0.05) 5 minutes before and after tilting among three groups. Five minutes before the end of test, Group 1 had obvious increase of T, VLF, LF and LF/HF while Group 2 and 3 had not such significant changes. There was significant difference(P<0.01) compared Group 1 with Group 2, 3. The results showed that the abnormal regulatory function of autonomic nervous system played an important role in the mechanism of symcope induced by HUT, the positive group had abnormal increase of sympathetic tone and imbalance of sympathetic/parasympathetic neural tone before syncope appeared.
