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Tekrarlayan Şüpheli Senkoplu Hastalarda Çift Doz Dilaltı Nitrogliserin ile Yapılan Eğik Masa Testinin Reprodusibilitesi

Yıl 2019, Cilt: 22 Sayı: 2, 107 - 111, 15.08.2019

Öz











Giriş: Eğik masa
testi senkop şüpheli hastalarda sıkça kullanılan bir testtir. Testin tanısal
değeri ve reprodusibilitesi hakkında karşıt görüşler mevcuttur. Çeşitli
serilerde pozitif bir testin reprodusibilitesi %36-90, negatif



bir testin
reprodusibilitesi ise %85-100 arasında bildirilmiştir. Biz bu çalışmada eğik
masa testinin güncel



reprodusibilitesini
araştırmayı hedefledik.



 



Hastalar ve Yöntem:
Hastanemizde Mayıs 2017-Ocak 2019 tarihleri arasında çift doz sublingual sprey
nitrogliserin ile test uygulanan tüm ardışık hastalar çalışmaya dahil edilmek
üzere değerlendirildi. Çalışmaya



katılmayı kabul eden
hastalar ilk testten 1-7 gün sonra ikinci bir teste alındılar.



 



Bulgular: Toplam 135
hasta [76 erkek (%56.3), 59 kadın (%43.7)] çalışmaya dahil edildi. Yaş aralığı
18-



61 ve ortalama yaş (±
SD) 32 ± 10.85 idi. İlk testte 81 (%60.0) hastada pozitif sonuç, 51 (%37.8)
hastada



negatif sonuç ve 3
(%2.2) hastada nitrata abartılı yanıt saptandı. İkinci testte ise 75 (%55.6)
hastada pozitif,



60 (%44.4) hastada
negatif sonuç saptandı. Pozitif reprodusibilite %85.2, negatif reprodusibilite
%88.2 ve



toplam
reprodusibilite %86.4 idi. Dilaltı nitratın yan etkilerine bağlı olarak test
hiçbir hastada sonlandırılmadı.



 



Sonuç: Seçilmiş
hastalarda çift doz dilaltı sprey nitrogliserin ile yapılan eğik masa testinin
güncel reprodusibilitesi yüksektir ve çift doz nitrogliserin kullanımı
güvenilir olabilir.



Kaynakça

  • 1. Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018;39:1883-948.
  • 2. Bartlett JW, Frost C. Reliability, repeatability and reproducibility: analysis of measurement errors in continuous variables. Ultrasound Obstet Gynecol 2008;31:466-75.
  • 3. Grubb BP, Wolfe D, Temesey-Armos P, Hahn H, Elliot P. Reproducibility of head-upright tilt table test results in patients with syncope. PACE 1992;15:1477-81.
  • 4. Sheldon RS, Splawinski J, Killam SB. Reproducibility of tilttable test in patientswithsyncope. Am J Cardiol 1992;69:1300-5.
  • 5. Brooks R, Ruskin JN, Powell AC, Newell J, Garan H, McGovern BA. Prospective evaluation of day-to-day reproducibility of upright tilt-table testing in unexplained syncope. Am J Cardiol 1993;71:1289-92.
  • 6. Ruiz GA, Scaglione J, Gonza´lez-Zuelgaray J. Reproducibility of head-uptilt testing in patients with syncope. Clin Cardiol 1996;19:215-20.
  • 7. Kou WH, Randall DK, Dorset DN, Koch KS. Immediate reproducibility of tilt-table test results in elderly patients referred for evaluation of syncope or presyncope. Am J Cardiol 1997;80:1442-4.
  • 8. Del Rosso A, Bartoli P, Bartoletti A, Brandinelli-Geri A, Bonechi F, Maioli M, et al. Shortened head-up tilt testing potentiated with sublingual nitroglycerin in patients with unexplained syncope. Am Heart J 1998;135:564-70.
  • 9. Barón-Esquivias G, Martínez-Rubio A. Tilt table test: state of the art. Indian Pacing Electrophysiol J 2003;3:239-52.
  • 10. Raviele A, Gasparini G, Di Pede F, Menozzi C, Brignole M, Dinelli M, et al. Nitroglycerin infusion during upright tilt: a new test for the diagnosis ofvaso-vagal syncope. Am Heart J 1994;127:103-11.
  • 11. Kochiadakis GE, Kanoupakis EM, Rombola AT, Igoumenidis NE, Chlouverakis GI, Vardas PE. Reproducibility of tilt table testing in patients with vasovagal syncope and its relation to variations in autonomic nervous system activity. Pacing Clin Electrophysiol 1998;21:1069-76.
  • 12. Sagristà-Sauleda J, Romero B, Permanyer-Miralda G, Moya A, Soler-Soler J. Reproducibility of sequential head-up tilt testing in patients with recent syncope, normal ECG and no structural heart disease. Eur Heart J 2002; 23:1706-13.
  • 13. Foglia-Manzillo G, Giada F, Beretta S, Corrado G, Santarone M, Raviele A. Reproducibility of head-up tilt testing potentiated with sublingual nitroglycerin in patients with unexplained syncope. Am J Cardiol 1999;84:284-8.
  • 14. Timoteo AT, Oliveira MM, Feliciano J, Antunes E, da Silva MN, Silva S, et al. Head-up tilt testing with different nitroglycerin dosages: experience in elderly patients with unexplained syncope. Europace 2008;10:1091-4.
  • 15. Aerts AJ, Dendale P, Strobel G, Block P. Sublingual nitrates during head-up tilt testing for the diagnosis of vasovagal syncope. Am Heart J 1997;133:504-7.
  • 16. Natale A, Sra J, Akhtar M, Kusmirek L, Tomassoni G, Leonelli F, et al. Use of sublingual nitroglycerin during head-up tilt testing in patients > 60 years of age. Am J Cardiol 1998;82:1210-3.
  • 17. Gieroba ZJ, Newton JL, Parry SW, Norton M, Lawson J, Kenny RA. Unprovoked and glyceryl trinitrate–provoked head-up tilt table test is safe in older people: a review of 10 years’ experience. J Am Geriatr Soc 2004;52:1913-5.
  • 18. Graham LA, Gray JC, Kenny RA. Comparison of provocative tests for unexplained syncope: isoprenaline and glyceryl trinitrate for diagnosing vasovagal syncope. Eur Heart J 2001;22:497-503.

Reproducibility of Tilt-Table Test Potentiated with Double Dose Sublingual Nitroglycerin in Patients with Suspected Recurrent Syncopal Episodes

Yıl 2019, Cilt: 22 Sayı: 2, 107 - 111, 15.08.2019

Öz











Introduction:
Tilt-table test (TT) is a noninvasive and safe test used for the diagnosis of
patients with syncope. Currently, there are controversies about the diagnostic
utility and reproducibility of TT. The reproducibility of TT has been reported
within a wide range from 36% to 90% for a positive test and from 85% to 100%
for a negative test. The aim of the present study was to investigate the
current reproducibility of TT.



 



Patients and Methods:
All consecutive patients who underwent TT with double dose spray nitroglycerin
due to suspected reflex syncope between May 2017 and January 2019 at our
hospital were evaluated. Patients underwent a second TT within 1-7 days
following the initial test.



 



Results: A total of
135 (76 female, 56.3% and 59 male, 43.7%) patients aged 18-61 (mean (± SD) 32 ±
10.85) years were included in the study. In the first test, 81 (60.0%) patients
had a positive response, 51 (37.8%) patients had a negative response, and 3
(2.2%) patients had an exaggerated response. In the repeated test, 75 (55.6%)
patients had a positive response, and 60 (44.4%) patients had a negative
response. The reproducibility of a positive tilt test was 85.2%, whereas the
reproducibility of a negative tilt test was 88.2%. Overall reproducibility was
86.4%.



 



Conclusion: In
selected patients, TT with double dose sublingual spray nitroglycerin has a
high reproducibility. Double dose sublingual spray nitroglycerin might be used
for potentiating TT with acceptable safety.



Kaynakça

  • 1. Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018;39:1883-948.
  • 2. Bartlett JW, Frost C. Reliability, repeatability and reproducibility: analysis of measurement errors in continuous variables. Ultrasound Obstet Gynecol 2008;31:466-75.
  • 3. Grubb BP, Wolfe D, Temesey-Armos P, Hahn H, Elliot P. Reproducibility of head-upright tilt table test results in patients with syncope. PACE 1992;15:1477-81.
  • 4. Sheldon RS, Splawinski J, Killam SB. Reproducibility of tilttable test in patientswithsyncope. Am J Cardiol 1992;69:1300-5.
  • 5. Brooks R, Ruskin JN, Powell AC, Newell J, Garan H, McGovern BA. Prospective evaluation of day-to-day reproducibility of upright tilt-table testing in unexplained syncope. Am J Cardiol 1993;71:1289-92.
  • 6. Ruiz GA, Scaglione J, Gonza´lez-Zuelgaray J. Reproducibility of head-uptilt testing in patients with syncope. Clin Cardiol 1996;19:215-20.
  • 7. Kou WH, Randall DK, Dorset DN, Koch KS. Immediate reproducibility of tilt-table test results in elderly patients referred for evaluation of syncope or presyncope. Am J Cardiol 1997;80:1442-4.
  • 8. Del Rosso A, Bartoli P, Bartoletti A, Brandinelli-Geri A, Bonechi F, Maioli M, et al. Shortened head-up tilt testing potentiated with sublingual nitroglycerin in patients with unexplained syncope. Am Heart J 1998;135:564-70.
  • 9. Barón-Esquivias G, Martínez-Rubio A. Tilt table test: state of the art. Indian Pacing Electrophysiol J 2003;3:239-52.
  • 10. Raviele A, Gasparini G, Di Pede F, Menozzi C, Brignole M, Dinelli M, et al. Nitroglycerin infusion during upright tilt: a new test for the diagnosis ofvaso-vagal syncope. Am Heart J 1994;127:103-11.
  • 11. Kochiadakis GE, Kanoupakis EM, Rombola AT, Igoumenidis NE, Chlouverakis GI, Vardas PE. Reproducibility of tilt table testing in patients with vasovagal syncope and its relation to variations in autonomic nervous system activity. Pacing Clin Electrophysiol 1998;21:1069-76.
  • 12. Sagristà-Sauleda J, Romero B, Permanyer-Miralda G, Moya A, Soler-Soler J. Reproducibility of sequential head-up tilt testing in patients with recent syncope, normal ECG and no structural heart disease. Eur Heart J 2002; 23:1706-13.
  • 13. Foglia-Manzillo G, Giada F, Beretta S, Corrado G, Santarone M, Raviele A. Reproducibility of head-up tilt testing potentiated with sublingual nitroglycerin in patients with unexplained syncope. Am J Cardiol 1999;84:284-8.
  • 14. Timoteo AT, Oliveira MM, Feliciano J, Antunes E, da Silva MN, Silva S, et al. Head-up tilt testing with different nitroglycerin dosages: experience in elderly patients with unexplained syncope. Europace 2008;10:1091-4.
  • 15. Aerts AJ, Dendale P, Strobel G, Block P. Sublingual nitrates during head-up tilt testing for the diagnosis of vasovagal syncope. Am Heart J 1997;133:504-7.
  • 16. Natale A, Sra J, Akhtar M, Kusmirek L, Tomassoni G, Leonelli F, et al. Use of sublingual nitroglycerin during head-up tilt testing in patients > 60 years of age. Am J Cardiol 1998;82:1210-3.
  • 17. Gieroba ZJ, Newton JL, Parry SW, Norton M, Lawson J, Kenny RA. Unprovoked and glyceryl trinitrate–provoked head-up tilt table test is safe in older people: a review of 10 years’ experience. J Am Geriatr Soc 2004;52:1913-5.
  • 18. Graham LA, Gray JC, Kenny RA. Comparison of provocative tests for unexplained syncope: isoprenaline and glyceryl trinitrate for diagnosing vasovagal syncope. Eur Heart J 2001;22:497-503.
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Orijinal Araştırmalar
Yazarlar

Çayan Çakır 0000-0002-2110-3178

Yayımlanma Tarihi 15 Ağustos 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 22 Sayı: 2

Kaynak Göster

Vancouver Çakır Ç. Reproducibility of Tilt-Table Test Potentiated with Double Dose Sublingual Nitroglycerin in Patients with Suspected Recurrent Syncopal Episodes. Koşuyolu Heart Journal. 2019;22(2):107-11.