Tilt testing remains a valuable asset

Author:

Sutton Richard1ORCID,Fedorowski Artur2ORCID,Olshansky Brian3ORCID,Gert van Dijk J4,Abe Haruhiko5,Brignole Michele6ORCID,de Lange Frederik7ORCID,Kenny Rose Anne8,Lim Phang Boon9,Moya Angel10,Rosen Stuart D11,Russo Vincenzo12,Stewart Julian M13ORCID,Thijs Roland D4ORCID,Benditt David G14

Affiliation:

1. Department of Cardiology, Imperial College, London, UK

2. Department of Cardiology, Skåne University Hospital and Lund University, Malmö, Sweden

3. Department of Cardiology, University of Iowa, Iowa City, IA, USA

4. Department of Neurology, Leiden University Medical Centre, The Netherlands

5. Department of Heart Rhythm Management, University of Occupational and Environmental Health, Kitakyushu, Japan

6. Istituto Auxologico Italiano, Faint & Fall Programme, Ospedale San Luca, Milano, Italy

7. Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Heart Centre, Amsterdam, The Netherlands

8. School of Medicine, Trinity College, Dublin, Ireland

9. Department of Cardiology, Hammersmith Hospital, Imperial College, London, UK

10. Department of Cardiology, Dexeus University Hospital, Barcelona, Spain

11. National Heart & Lung Institute, Royal Brompton Hospital, Imperial College, London, UK

12. Department of Translational Sciences, University of Campania, Naples, Italy

13. Department of Pediatrics, New York Medical College, Valhalla, NY, USA

14. Cardiac Arrhythmia Center, Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA

Abstract

Abstract Head-up tilt test (TT) has been used for >50 years to study heart rate/blood pressure adaptation to positional changes, to model responses to haemorrhage, to assess orthostatic hypotension, and to evaluate haemodynamic and neuroendocrine responses in congestive heart failure, autonomic dysfunction, and hypertension. During these studies, some subjects experienced syncope due to vasovagal reflex. As a result, tilt testing was incorporated into clinical assessment of syncope when the origin was unknown. Subsequently, clinical experience supports the diagnostic value of TT. This is highlighted in evidence-based professional practice guidelines, which provide advice for TT methodology and interpretation, while concurrently identifying its limitations. Thus, TT remains a valuable clinical asset, one that has added importantly to the appreciation of pathophysiology of syncope/collapse and, thereby, has improved care of syncopal patients.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine

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