Brand new publication by the expert team from Italy lead by Dr. Vincenzo Russo from the University of Campania, Monaldi Hospital in Naples.
Short-duration head-up tilt test potentiated with sublingual nitroglycerin in suspected vasovagal syncope: the fast Italian protocol
The European Society of Cardiology recently published a highly interesting study that might revolutionize tilt table testing not only in terms of saving time and cost but also in terms of acceptance and implementation in daily clinical routine. A shorter protocol might increase the utilization of head-up tilt testing to assess hemodynamic responses in patients with vasovagal syncope.
“The traditional nitroglycerin (NTG) head-up tilt test (HUTT) is time-consuming and the test duration is a barrier to wide-spread utilization in clinical practice. It was hypothesized that a short-duration protocol is not inferior to the traditional protocol regarding the positivity rate and has similar distribution of hemodynamic response”1
> Tilt Test Protocols & Procedure
The same number of patients were randomly assigned to both the fast and the traditional head-up tilt test protocol (n=277 each).
The traditional protocol involves a 5-minute supine phase, a 20-minute tilt passive phase, and a 15-minute NTG phase, while in the shortened protocol, a 5-minute supine phase is followed by a 10-minute tilt phase and a 10-minute NTG phase.
> Results & Prospects
The authors concluded that “the diagnostic yield of the fast protocol is similar to that of traditional HUTT, therefore the fast protocol can be used instead.”1
Moreover, the duration of the tilt test could be shortened by 38% from 40 to 25 minutes which means that using the fast protocol allows for an examination of almost twice as many patients in the same time period.
Russo, V. et al., Short-duration head-up tilt test potentiated with sublingual nitroglycerin in suspected vasovagal syncope: the fast Italian protocol. European Heart Journal (2023) 00, 1-7; doi.org/10.1093/eurheart/ehead322