| Late hemodynamic changes during a negative passive head-up tilt predict the symptomatic outcome to a nitroglycerin sensitized tilt. | |
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MedLine Citation:
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PMID: 15679637 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Sublingual nitroglycerin is advocated to sensitize the passive 70 degrees head-upright tilt test (HUTT) of patients with unexplained syncope. We hypothesized that a detailed analysis of hemodynamic responses recorded during a negative HUTT could predict the outcome to a subsequent nitroglycerin sensitized HUTT (NTG-HUTT). METHODS: Thirty-two patients (46 +/- 3 years, 17 males) with recurrent unexplained syncope but a negative HUTT were included. Heart rate, arterial blood pressure, and central hemodynamics assessed by transthoracic impedance (preejection and rapid left ventricular ejection time, slow ejection time, peak amplitude of first derivative, and cardiac index) were recorded during supine rest and 45 minutes HUTT. Changes from supine rest of the variables were retrospectively compared between patients with a negative (n = 15, NTG-HUTT(-)) and positive (n = 17, NTG-HUTT(+)) outcome to 10 minutes subsequent NTG-HUTT. RESULT: Significant differences between groups were observed during the 15th-20th minutes (Italian protocol) and during the last 5 minutes of passive HUTT (Westminster protocol). The combination of cutoff values, determined by receiver operating curves, on hemodynamic variables changes during the last 5 minutes predicted the outcome to a NTG-HUTT with a sensitivity of 76% and a specificity of 87%. The cutoff values determined during 15th-20th minutes gave an attractive sensitivity (85%) but a too weak specificity (53%) to shorten the 45 minutes passive HUTT at 20 minutes. CONCLUSION: Outcome to a NTG-HUTT can be reliably predicted by selected criteria determined from multiple hemodynamic variables recorded during a passive 70 degrees HUTT. |
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Authors:
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Elisabeth Bellard; Jacques-Olivier Fortrat; Daniel Schang; Jean-Marc Dupuis; Jacques Victor; Georges Lefthériotis |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Pacing and clinical electrophysiology : PACE Volume: 28 ISSN: 0147-8389 ISO Abbreviation: Pacing Clin Electrophysiol Publication Date: 2005 Feb |
Date Detail:
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Created Date: 2005-01-31 Completed Date: 2005-06-02 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7803944 Medline TA: Pacing Clin Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 89-96 Citation Subset: IM |
Affiliation:
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Laboratoire de Physiologie, Faculté de Médecine, Angers Cedex, France. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Analysis of Variance Blood Pressure / drug effects, physiology Cardiography, Impedance Female Heart Rate / drug effects, physiology Hemodynamics / drug effects, physiology* Humans Male Middle Aged Nitroglycerin / administration & dosage* Predictive Value of Tests ROC Curve Retrospective Studies Sensitivity and Specificity Statistics, Nonparametric Supine Position Syncope / drug therapy, physiopathology* Tilt-Table Test* Vasodilator Agents / administration & dosage* |
| Chemical | |
Reg. No./Substance:
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0/Vasodilator Agents; 55-63-0/Nitroglycerin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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