(Circulation. 1996;93:973-981.)
© 1996 American Heart Association, Inc.
Articles |
Risk Factors for Syncope Recurrence After a Positive Tilt-Table Test in Patients With Syncope
From the Cardiovascular Research Group, University of Calgary, Calgary, Alberta, Canada.
Correspondence to Dr Robert Sheldon, Division of Cardiology, Calgary General Hospital, 841 Centre Ave E, Calgary, Alberta, Canada T2E 0A1.
Background Recent work with head-up tilt-table testing has suggested that many patients with syncope may have recurrent neurally mediated episodes of bradycardia, hypotension, or both. The purpose of this study was to determine how to identify patients at high risk of a recurrence of neuromediated syncope after a positive isoproterenol/tilt-table test.
Methods and Results A cohort of 101 drug-free patients in a
university hospital outpatient clinic with syncope and a positive
isoproterenol/tilt-table test underwent baseline assessment of
demographic variables, symptomatic burden, and
hemodynamic and clinical responses to tilt testing. The
primary outcome measure was the time to the first recurrent syncopal
spell. The actuarial probabilities of remaining syncope free after 1
and 2 years were 72% and 60%, respectively.
Multivariate proportional hazards analysis
demonstrated that the most powerful predictor of a recurrence
of syncope was the logarithm of the number of preceding syncopal spells
(P<.001). Other predictive variables included the
duration of syncopal symptoms, tilt-test symptomatic
outcome, and trough heart rate. The probability of a recurrence
of syncope also varied with the logarithm of the frequency of preceding
spells (P=.008). The median frequency of pretest spells was
0.3/month; after the tilt test, the median frequency dropped 
90% to
0.03 per month.
Conclusions The risk of a recurrence of syncope after a positive tilt-table test can be predicted with simple pretest and intratest variables.
Key Words: syncope • prognosis • follow-up studies • tilt-table tests
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