Syncope: More people with syncope had symptoms on tilt testing than those without

Clinical bottom line (level 4)

  1. In patients who had a syncopal response to head up tilt testing were likely to have experienced previous syncopal attacks (NNH = 3 at unknown)
Oribe et al: Pace 1997; 20 (1): 874-879
Expires January 2004

The study

Case-control study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: referral centre for syncope evaluation, USA

201 patients (aged mean 51 years 95% CI 48-55), 57% female) unexplained syncope

Excluded if
  • adrenoreceptor affecting drugs
  • anticholinergics
  • fludrocortisone


    • Cases: 201 patients (57% female, mean age 51): unexplained syncope
    Controls: 102 patients (55% female, mean age 54): non-syncopal controls

    Factors studied:
  • positive test


    • Factors summarised:
  • history of syncope


    • Outcomes studied:
  • positive test defined as hypotension with bradycardia and symptoms

    • Patients underwent head-up tilt tests. Subjects were passively tilted to a 60 ° C head-up position in fifteen seconds.

    The evidence

    Patient expected event rate for positive test: 37%
    risk factor positive test
    present    		 positive test
    absent    		 unadjusted OR
    (95% CI)    		 NNH
    (95% CI)
    history of syncope 74 127 6.3
    (2.8 to 14)     		3
    (1 to 9)
    no history of syncope 6 96

    Comments

    1. Study demonstrates no clinical difference between those who head-up tilt positive and those who are negative

    Citation

    1. Oribe E, Caro S, Perera R, et al: Syncope: the diagnostic value of head-up tilt testing. Pace 1997; 20 (1): 874-879
    Contributor: Bob Phillips and Clare Wotton, February 2000
    Reviewer:

    Clinical Question.
    Patient syncope
    Intervention or Exposure head-up tilt testing
    Outcome syncope;