Cargando…

What is the optimal duration of the TILT after administration of 0.4 mg nitroglycerin spray?

Performing a head-up tilt test can be of great value for the diagnosis of vasovagal syncope. The European Society of Cardiology recommends a drug challenge phase duration of 15 to 20 minutes, with either Isoprenaline or Nitroglycerin administration. We sought to investigate the outcome of a ten-minu...

Descripción completa

Detalles Bibliográficos
Autores principales: Glockler, Antonia, Cismaru, Gabriel, Istratoaie, Sabina, Gusetu, Gabriel, Zdrenghea, Dumitru, Pop, Dana, Rosu, Radu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440280/
https://www.ncbi.nlm.nih.gov/pubmed/32176097
http://dx.doi.org/10.1097/MD.0000000000019510
_version_ 1783573139818545152
author Glockler, Antonia
Cismaru, Gabriel
Istratoaie, Sabina
Gusetu, Gabriel
Zdrenghea, Dumitru
Pop, Dana
Rosu, Radu
author_facet Glockler, Antonia
Cismaru, Gabriel
Istratoaie, Sabina
Gusetu, Gabriel
Zdrenghea, Dumitru
Pop, Dana
Rosu, Radu
author_sort Glockler, Antonia
collection PubMed
description Performing a head-up tilt test can be of great value for the diagnosis of vasovagal syncope. The European Society of Cardiology recommends a drug challenge phase duration of 15 to 20 minutes, with either Isoprenaline or Nitroglycerin administration. We sought to investigate the outcome of a ten-minute active phase with Nitroglycerin in patients suspected of vasovagal syncope and determine the percentage of loss in the positivity rate, using this short duration approach. We consecutively enrolled patients presenting with syncope undergoing the head-up tilt test (HUTT), with a clinical suspicion of vasovagal syncope between the years 2009 to 2019. The HUTT consisted of 2 successive phases: passive and active. During the passive phase, the patients were tilted at 70° for 20 minutes. If negative, the test was continued after administration of 0.4 mg sublingual Nitroglycerin. Applying the (VASIS) Vasovagal Syncope International Study classification of the vasovagal syncope international study and comparing for age and gender, positive responses were categorized into 3 types. A number of 306 patients (age = 43.5 +/−20.3; male = 140 [45.7%]) with suspected vasovagal syncope, undergoing HUTT, were enrolled in the years of 2009 to 2019. Of those, 245 (80.2%) presented a positive test, with 200 patients (82.0%) during the being positive during the active phase of the test. The results were as follows: 116 subjects (47.2%) presented with a mixed response (VASIS I), 52 (21.3%) showed a cardio inhibitory response (VASIS II), and 77 (31.5%) displayed a vasodepressor response (VASIS III). We found no relationship between the type of syncope with neither gender, nor age of the patient. Three minutes represented the median time to positivity, after Nitroglycerine administration. The time distribution showed a peak incidence appearing between minutes 3 and 5, ranging from 1 to 20 minutes. Only 3 patients tested positive after minute 10. Shortening the active phase to 10 minutes would result in a positivity rate loss of 1.5%.
format Online
Article
Text
id pubmed-7440280
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Wolters Kluwer Health
record_format MEDLINE/PubMed
spelling pubmed-74402802020-09-04 What is the optimal duration of the TILT after administration of 0.4 mg nitroglycerin spray? Glockler, Antonia Cismaru, Gabriel Istratoaie, Sabina Gusetu, Gabriel Zdrenghea, Dumitru Pop, Dana Rosu, Radu Medicine (Baltimore) 3400 Performing a head-up tilt test can be of great value for the diagnosis of vasovagal syncope. The European Society of Cardiology recommends a drug challenge phase duration of 15 to 20 minutes, with either Isoprenaline or Nitroglycerin administration. We sought to investigate the outcome of a ten-minute active phase with Nitroglycerin in patients suspected of vasovagal syncope and determine the percentage of loss in the positivity rate, using this short duration approach. We consecutively enrolled patients presenting with syncope undergoing the head-up tilt test (HUTT), with a clinical suspicion of vasovagal syncope between the years 2009 to 2019. The HUTT consisted of 2 successive phases: passive and active. During the passive phase, the patients were tilted at 70° for 20 minutes. If negative, the test was continued after administration of 0.4 mg sublingual Nitroglycerin. Applying the (VASIS) Vasovagal Syncope International Study classification of the vasovagal syncope international study and comparing for age and gender, positive responses were categorized into 3 types. A number of 306 patients (age = 43.5 +/−20.3; male = 140 [45.7%]) with suspected vasovagal syncope, undergoing HUTT, were enrolled in the years of 2009 to 2019. Of those, 245 (80.2%) presented a positive test, with 200 patients (82.0%) during the being positive during the active phase of the test. The results were as follows: 116 subjects (47.2%) presented with a mixed response (VASIS I), 52 (21.3%) showed a cardio inhibitory response (VASIS II), and 77 (31.5%) displayed a vasodepressor response (VASIS III). We found no relationship between the type of syncope with neither gender, nor age of the patient. Three minutes represented the median time to positivity, after Nitroglycerine administration. The time distribution showed a peak incidence appearing between minutes 3 and 5, ranging from 1 to 20 minutes. Only 3 patients tested positive after minute 10. Shortening the active phase to 10 minutes would result in a positivity rate loss of 1.5%. Wolters Kluwer Health 2020-03-13 /pmc/articles/PMC7440280/ /pubmed/32176097 http://dx.doi.org/10.1097/MD.0000000000019510 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0
spellingShingle 3400
Glockler, Antonia
Cismaru, Gabriel
Istratoaie, Sabina
Gusetu, Gabriel
Zdrenghea, Dumitru
Pop, Dana
Rosu, Radu
What is the optimal duration of the TILT after administration of 0.4 mg nitroglycerin spray?
title What is the optimal duration of the TILT after administration of 0.4 mg nitroglycerin spray?
title_full What is the optimal duration of the TILT after administration of 0.4 mg nitroglycerin spray?
title_fullStr What is the optimal duration of the TILT after administration of 0.4 mg nitroglycerin spray?
title_full_unstemmed What is the optimal duration of the TILT after administration of 0.4 mg nitroglycerin spray?
title_short What is the optimal duration of the TILT after administration of 0.4 mg nitroglycerin spray?
title_sort what is the optimal duration of the tilt after administration of 0.4 mg nitroglycerin spray?
topic 3400
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440280/
https://www.ncbi.nlm.nih.gov/pubmed/32176097
http://dx.doi.org/10.1097/MD.0000000000019510
work_keys_str_mv AT glocklerantonia whatistheoptimaldurationofthetiltafteradministrationof04mgnitroglycerinspray
AT cismarugabriel whatistheoptimaldurationofthetiltafteradministrationof04mgnitroglycerinspray
AT istratoaiesabina whatistheoptimaldurationofthetiltafteradministrationof04mgnitroglycerinspray
AT gusetugabriel whatistheoptimaldurationofthetiltafteradministrationof04mgnitroglycerinspray
AT zdrengheadumitru whatistheoptimaldurationofthetiltafteradministrationof04mgnitroglycerinspray
AT popdana whatistheoptimaldurationofthetiltafteradministrationof04mgnitroglycerinspray
AT rosuradu whatistheoptimaldurationofthetiltafteradministrationof04mgnitroglycerinspray