Syncope: tilt table testing: positive results are common in patients with or without syncope.

Clinical bottom line (level 2a)

  1. Positive tilt-table tests are common in patients with or without syncope.
  2. There is no clear difference between passive tilting and using isoproterenol.
Kapoor et al: American Journal of Medicine 1994; 97: 78-88
Expires October 2004

The study

Systematic review of all studies of
  • Patients: with syncope of unknown cause compared with controls without syncope or with a known cause
  • Intervention: undergoing tilt table testing
  • Outcome: positive tilt test


    • Articles found in English using MEDLINE, 1966 to 1992 (search terms: syncope, presyncope, loss of consciousness, vasovagal syncope, vasodepressor syncope, and tilt ) and reviewing bibliographic references of selected articles

    Selection criteria: as above- by two independent reviewers
    Appraisal criteria: not detailed
    Articles excluded if:
    • no original data or a case report
    • comparing seizures and syncope


    23 studies were found

    The evidence

    • % of patients with a positive test result: passive tilt:
      • control: 0% to 69%
      • syncope of unknown origin: 26% to 90%
    • % of patients with a positive test result: isoproterenol tilt
      • control: 0% to 83%
      • syncope of unknown origin: 39% to 87%

    Comments

    1. By only restricting searching to MEDline potential useful articles may not have been found.
    2. No study had a reference standard, thus making the clinical value of a positive or negative test uncertain.

    Citation

    1. Kapoor WN, Smith MA, Miller NL: Upright tilt testing in evaluating syncope: a comprehensive literature review. American Journal of Medicine 1994; 97: 78-88
    Contributor: Chris Ball and Clare Wotton, October 2000
    Reviewer:

    Clinical Question.
    Patient syncope
    Intervention or Exposure prevalence
    Outcome positive tilt-table test