Objective: To evaluate the diagnostic and prognostic contribution of tilt
testing in the assessment of unexplained syncope. Patients and Methods: All
patients who had a tilt test at Abidjan Heart Institute between October 2014
and May 2015 (a period of eight months) were included and followed in this
study. During the monitoring period, patients were interviewed in consultation
and examination room. Results: A tilt test
was performed in 60 patients with mean age of 45 ± 20 years, with a sex
ratio of a man for a woman referred to our service for exploration of
unexplained syncope. The tilt in dorsal decubitus test was negative in all
patients. In inclined position the test was positive in 10 patients (17%), and then
in inclined position with instillation of glyceryl trinitrate the test was
positive in 35 patients (58%). The tilt test was positive in 45 patients or
75%. The responses were observed vaso-depressive response in 22 patients, a
mixed response in 8 patients, and cardio-inhibitory response in 15 patients.
After three months follow-up, through lifestyle changes, through recognition of
early symptoms, regular rehydration by the eviction of confined atmospheres,
and the reduction of antihypertensive treatment, adoption of the dorsal
decubitus or position sitting at the onset of symptoms, 95% of patients had not
presented any recurrence of symptoms. The incidence of recurrence was the same
regardless of the type of response to the tilt test. Conclusion: The tilt test
is easily achievable but disregarded under review and used in our health
centers. It has some diagnostic value in exploring the unexplained syncope. The
syncope recurrence rate after a tilt test is very low.
Cite this paper
Koffi, J. D. N. B. (2015). Diagnostic Value of Test Tilt in Unexplained Syncope—A Heart Institute Abidjan. Open Access Library Journal, 2, e2060. doi: http://dx.doi.org/10.4236/oalib.1102060.
Blanc, J.J., L’Her, C., Touiza, A., et
al. (2002) Prospective
Evaluation and Out-Come of Patients Admitted for Syncope over a 1 Year Period. European Heart Journal, 23, 815-820. http://dx.doi.org/10.1053/euhj.2001.2975
Disertori, M., Brignole, M., Menozzi, C., et al. (2003) Management of Patients with Syncope Referred Urgently to General
Hospitals.Europace, 5, 283-291. http://dx.doi.org/10.1016/S1099-5129(03)00049-7
Sheldon, R., Rose, S., Flanagan, P., Koshman, M.L. and Killiam, S. (1996) Risk Factors for Syncope Recurrence after a Positive Tilt-Test in Patients with Syncope. Circulation, 93, 973-981. http://dx.doi.org/10.1161/01.CIR.93.5.973
Njoo, Z., Alizadeh, A., Alasti, M., Fadaie, A.A., Haghjoo, M., Fazelifar, A.F., et al. (2007) Correlation between Results of Head-Up Tilt Test and Clinical Features in Patients with Syncope or Presyncope. Journal of Electrocardiology, 40, 200-202. http://dx.doi.org/10.1016/j.jelectrocard.2006.07.006
Moya, A., Sutton, R., Ammirati, F., Blanc, J.J., Brignole, M., Dahm, J.B., et al. (2009) Guideline for the Diagnosis and Management of Syncope (Version 2009):
The Task Force for the Diagnosis and Management of Syncope of the European
Society of Cardiogy (ESC). European Heart Journal, 30, 2631-2671. http://dx.doi.org/10.1093/eurheartj/ehp298
Linzer, M., Yang, E.H., Estes III, N.A., et al. (1997)
Diagnosing Syncope. Part II:
Unexplained Syncope. Clinical Efficacy Assessment Project of the American
College of Physicians. Annals of Internal
Medicine, 127, 1352-1355. http://dx.doi.org/10.7326/0003-4819-127-1-199707010-00014
Macebo, P.G., Asirvatham, S.J., Maia, L., Ferreira Neto, E., Zanatta, A., Sobral Neto, J., et al. (2012) Comparison of a Shortened Isosorbide Dinitrate-Potentiated Head-Up Tilt Test Testing with the Conventional Protocol: Tolerance and
Diagnostic Accuracy. Pacing and Clinical
Electrophysiology, 35, 1005-1011. http://dx.doi.org/10.1111/j.1540-8159.2012.03440.x
Khan, H.F., Hameed, M.A. and
Khan, U.A. (2010)
Short Duration Head-Up Tilt Test:
A Comparison with Conventional Long Protocol in Patients of Orthostatic Ontolerance. Annals of Noninvasive Electrocardiology, 15, 101-106.
Exposito, V., Guzman, J.C., Orava, M., Armaganijan, L. and Morillo, C.A. (2013)
Usefulness of the Calgary
Syncope Symptom Score for the Diagnosis of Vasovagal Syncope in the Elderly. Placing Clinical Electrophysiol, 36, 37-41. http://dx.doi.org/10.1093/europace/eut042
Moya, A., Permanyer-Miralda, G., Sagrista-Sauleda, J., et al. (1955) Limitations of Head-Up Tilt Test for Evaluating the Efficacity of Therapeutic
Interventions in Patients with Vaso-Vagal Syncope; Results of a Controlled
Study of Etilefrine versus Placebo. Journal of the American College
of Cardiology, 25, 65-69. http://dx.doi.org/10.1016/0735-1097(94)00336-O
Kenny, R.A., Ingram, A., Bayliss, J. and Sutton, R. (1986)
Head-Up Tilt: A Useful Test for Investigating Unexplained Syncope. Lancet, 1, 1352-1355. http://dx.doi.org/10.1016/S0140-6736(86)91665-X
Domenichini, G., Diemberger, I., Biffi, M., Martignani, C., Valzania, C., Bertini, M., et al. (2010) Long-Term Follow- Up of Patients with Syncope Evaluated by Head-Up Tilt Test.Annals
of Noninvasive Electrocardiology, 15, 101-106. http://dx.doi.org/10.1111/j.1542-474X.2010.00349.x