Abstract
Background
A systematic evaluation focused on sensitivity and specificity of head-up tilt testing
(HUT) for diagnosing vasovagal syncope has not been previously performed. We conducted
a meta-analysis of studies comparing HUT outcome between patients with syncope of
unknown origin and control subjects without previous syncope.
Methods
We searched Pubmed and Embase databases for all English-only articles concerning case-control
studies estimating the diagnostic yield of HUT, and selected 55 articles, published
before March 2012, including 4361 patients and 1791 controls. The influence of age,
test duration, tilt angle, and nitroglycerine or isoproterenol stimulation on tilt
testing outcome was analyzed.
Results
Head-up tilt testing demonstrated to have a good overall ability to discriminate between
symptomatic patients and asymptomatic controls with an area under the summary receiver-operating
characteristics curve of 0.84 and an adjusted diagnostic odds ratio of 12.15 (p<0.001). A significant inverse relationship between sensitivity and specificity of
tilt testing for each study was observed (p<0.001). At multivariate analysis, advancing age and a 60° tilt angle showed a significant
effect in reducing sensitivity and increasing specificity of the test. Nitroglycerine
significantly raised tilt testing sensitivity by maintaining a similar specificity
in comparison to isoproterenol.
Conclusions
The results from this meta-analysis show the high overall performance of HUT for diagnosing
vasovagal syncope. Our findings provide useful information for evaluating clinical
and instrumental parameters together with pharmacological stressors influencing HUT
accuracy. This could allow the drawing of tilt testing protocols tailored on the diagnostic
needs of each patient with unexplained syncope.
Keywords
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Article info
Publication history
Published online: October 05, 2012
Accepted:
September 12,
2012
Received in revised form:
June 1,
2012
Received:
January 22,
2012
Identification
Copyright
© 2012 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
