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Clinical Autonomic Research

, Volume 20, Issue 3, pp 167–173 | Cite as

Clinical predictors of head-up tilt test outcome during the nitroglycerin phase

  • Massimo IacovielloEmail author
  • Cinzia Forleo
  • Pietro Guida
  • Marco Matteo Ciccone
  • Sandro Sorrentino
  • Valentina D’Andria
  • Mariligia Panunzio
  • Stefano Favale
Research Article

Abstract

Objectives

Nitrate-stimulated head-up tilt testing (HUT) is currently recommended to confirm the diagnosis of vasovagal syncope in subjects with syncope of unknown origin. Given the few data currently available, the aim of this study was to assess correlations between nitrate-induced HUT outcomes and the clinical characteristics of patients.

Methods

Two hundred and thirty consecutive, otherwise healthy subjects with a history of recurrent unexplained syncope underwent HUT. After 10 min supine rest, they were tilted to 70°, and the test was potentiated by the administration of 300 μg of nitroglycerin after 20 min.

Results

Out of 178 subjects who underwent nitroglycerin administration during HUT, 95 fainted. At univariate Cox regression analysis, a reduced probability of VVS occurrence after nitrates was associated with greater systolic blood pressure and body mass index values, to male gender and smoking. At multivariate Cox regression analysis, only male gender (HR = 0.61; P = 0.039) and smoking (HR = 0.18; P = 0.001) remained significantly associated with HUT outcomes during the pharmacological phase of the test.

Interpretation

Smokers and males are less likely to faint after nitrate administration during HUT than non-smokers and females. Further studies should clarify the possibility of improving the diagnostic power of HUT in these patients.

Keywords

Vasovagal syncope Tilt-table testing Nitroglycerin Gender Smoking 

Notes

Acknowledgments

This study was partially supported by a grant from the University of Bari. The authors would like to thank Dr. Angela Ferrara, Mr. Cataldo Balducci and Mrs. Margherita Sarlo for their helpful cooperation.

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Massimo Iacoviello
    • 1
    Email author
  • Cinzia Forleo
    • 1
  • Pietro Guida
    • 1
  • Marco Matteo Ciccone
    • 1
  • Sandro Sorrentino
    • 1
  • Valentina D’Andria
    • 1
  • Mariligia Panunzio
    • 1
  • Stefano Favale
    • 1
  1. 1.Cardiology Unit, Emergency and Organ Transplantation DepartmentUniversity of BariBariItaly

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