Safety and tolerability of Tilt Testing and Carotid Sinus Massage in the octogenarians
Open accessAbstract
OBJECTIVE: to evaluate the safety and tolerability of Tilt Testing (TT) and Carotid Sinus Massage (CSM) in octogenarians with unexplained syncope. METHODS: patients consecutively referred for transient loss of consciousness to the 'Syncope Units' of three hospitals were enrolled. TT and CSM were performed according to the European Society of Cardiology guidelines on syncope. Complications were evaluated in each group. An early interruption of TT was defined as 'intolerance' and considered as a non-diagnostic response. RESULTS: one thousand four hundred and one patients were enrolled (mean age 72 ± 16 years, male 40.8%). Six hundred and ninety-four patients (49.5%) were 80 years old or older (mean age 83 ± 3 years) and 707 (50.5%) were younger (mean age 60 ± 17 years). Complications after TT occurred in 4.5% of older patients and in 2.1% of the younger ones (P = 0.01). All complications were 'minor/moderate', as prolonged hypotension, observed in ∼3% of patients ≥80 years. Major complications such as sustained ventricular tachycardia, ventricular fibrillation, asystole requiring cardiac massage, transient ischaemic attack, stroke and death were not observed in any patient. The presence of orthostatic hypotension and the mean number of syncopal episodes were predictors of TT complications. Intolerance was reported in 2.4% of older patients and 1% of the younger ones (P = 0.08), mainly due to orthostatic intolerance. No complications occurred after CSM. CONCLUSIONS: TT and CSM appear to be safe and well tolerated in octogenarians, who should not be excluded by age from the diagnostic work-up of syncope.
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When pooling data from four studies in which 8720 patients were analysed, transient ischaemic attacks or strokes were observed in 21 patients (0.24%) after carotid sinus massage.
“When pooling the data from four studies 90,95-97 in which 8720 patients were analysed, TIAs or strokes were observed in 21 (0.24%).”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [96]
The Discussion reports that neurological complications after carotid sinus massage are uncommon, with published rates of 0.17–0.45%, which is consistent with the claimed 0.24%. It does not report a pooled analysis of four studies, 8,720 patients, or 21 TIAs or strokes; the Methods describe this paper's study of 1,401 patients. (LLM, conf=0.84)
Experimental — accuracy not yet measuredOrthostatic blood pressure measurements, carotid sinus massage, and tilt testing are well tolerated, even in the frail elderly with cognitive impairment.
“Orthostatic BP measurements, CSM, and tilt testing are well tolerated, even in the frail elderly with cognitive impairment. 96,396,397”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [96]
The Conclusions state that tilt testing and carotid sinus massage were safe and well tolerated in octogenarians. The Methods say patients also had orthostatic BP measurements, but the paper does not report their tolerability or establish that the findings apply to frail patients with cognitive impairment; the Discussion calls for more study of shortened tilt protocols in frail patients. (LLM, conf=0.90)
Experimental — accuracy not yet measured
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- Authors
- Ungar, A., Rivasi, G., Rafanelli, M., Toffanello, G., Mussi, C., Ceccofiglio, A., McDonagh, R., Drumm, B., Marchionni, N., Alboni, P., & Kenny, R. A.
- Affiliations
- Azienda Ospedaliero-Universitaria Careggi (IT)
- University of Modena and Reggio Emilia (IT)
- Trinity College Dublin (IE)
- Corresponding author
- Ungar, Andrea
- ORCID
- Venue
- Age and Ageing
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-01-31
- Volume
- 45
- Issue
- 2
- Pages
- 242-248
- ISSN
- 0002-0729 (ISSN-L)
- 1468-2834
- OpenAlex
- W2304280422
- Cited by
- 35
- References
- 30
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 2 · 2021: 5 · 2020: 2 · 2019: 2 · 2018: 5 · 2017: 2 · 2016: 2
- FWCI
- 4.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Age and Ageing (publishedVersion)
- PubMed (publishedVersion)
- Arrow@dit (Dublin Institute of Technology) (submittedVersion)
- Florence Research (University of Florence) (submittedVersion, other-oa)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- HighWire Press Open Archive (submittedVersion)
- Trinity's Access to Research Output (TARA) (Trinity College Dublin) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Keywords
- tilt table test, carotid sinus massage, syncope, octogenarians, elderly patients, diagnostic safety, tolerability, orthostatic hypotension, orthostatic intolerance, procedural complications, transient loss of consciousness
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Carotid Sinus, Female, Health Services for the Aged, Health Services Research, Humans, Ireland, Italy, Male, Massage, Middle Aged, Predictive Value of Tests, Prospective Studies, Risk Factors, Syncope, Geriatric Assessment, Tilt-Table Test
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