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Twenty-eight years of research permit reinterpretation of tilt-testing: hypotensive susceptibility rather than diagnosis
Abstract
There is growing scepticism over utility of tilt-testing for syncope diagnosis, which has been shown unable to distinguish vasovagal from other syncope, especially cardiac, despite its acceptable sensitivity and specificity in true positive and negative subjects. The new interpretation is that the test reveals a susceptibility to reflex hypotension, which may exist in coincidence with any cause of syncope. This implies an important change in patient management including selecting effective therapy, in particular in guiding pacemaker therapy in patients affected by reflex syncope.
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“In these patients, a positive tilt test reveals a susceptibility to orthostatic stress. 132”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [132]
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Self-citationRusso, V., Comune, A., Nardo, G. D., Parente, E., Marco, G. M. D., Nigris, A. D., Russo, M. G., Sarubbi, B., Nigro, G., & Brignole, M. (2025) · Clinical Autonomic Research · doi:10.1007/s10286-025-01145-5 · Cited by 2
Self-citationNovel Therapeutic Options in the Management of Reflex Syncope
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Táborský, M., Kautzner, J., Fedorco, M., Čurila, K., Wünschová, H., Pyszko, J., Novák, M., Kozák, M., Válek, M., Polášek, R., et al. (2022) · Cor et Vasa · doi:10.33678/cor.2022.024 · Cited by 4
Prakash, A., & Sutton, R. (2023) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.15991 · Cited by 2
Self-citationDizziness, Syncope, and Autonomic Dysfunction in Children
Kakavand, B. (2022) · Progress in Pediatric Cardiology · doi:10.1016/j.ppedcard.2022.101512 · Cited by 2
Clinical Presentation and Diagnosis of Vasovagal Syncope
Alboni, P., Dipaola, F., Coppola, P., & Furlan, R. (2014) · Springer eBooks · doi:10.1007/978-3-319-09102-0_11 · Cited by 2
Evaluation and Management of Reflex Vasovagal Syncope—A Review
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Idiaquez, J. F., Benarroch, E. E., & Nogués, M. A. (2018) · Springer eBooks · doi:10.1007/978-3-319-72251-1_12 · Cited by 2
Tilt test in paced patients: Is it worth the effort?
Bhargava, K. (2015) · Indian Pacing and Electrophysiology Journal · doi:10.1016/j.ipej.2015.10.009 · Cited by 2
Sutton, R. (2017) · Journal of Internal Medicine · doi:10.1111/joim.12642 · Cited by 2
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Primary cerebral autoregulation dysfunction: a distinct subtype of vasovagal syncope
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Syncope and Unexplained Falls in the Elderly
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Self-citationPacing in neurocardiogenic/vasovagal syncope
Sutton, R. (2018) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-018-0564-0 · Cited by 1
Self-citation2018 KHRS guideline for the evaluation and management of syncope-Part 1
Park, J., Cha, M.-J., Kim, D. H., Kim, Y. R., Mun, H. S., Bae, E. J., Seo, D. W., Song, M. K., Ahn, J., Yoon, H. D., et al. (2018) · International Journal of Arrhythmia · doi:10.18501/arrhythmia.2018.009 · Cited by 1
2018 KHRS guideline for the evaluation and management of syncope-Part 2
Kim, Y. R., Chun, K. J., Kim, J. S., Mun, H. S., Park, J., Seo, D. W., Song, M. K., Ahn, J. H., Yoon, H. J., Lee, D. I., et al. (2018) · International Journal of Arrhythmia · doi:10.18501/arrhythmia.2018.010 · Cited by 1
von Scheidt, W., Klingenheben, T., & BOSCH, R. F. (2020) · Der Internist · doi:10.1007/s00108-020-00821-0 · Cited by 2
Ungar, A., Rafanelli, M., Rivasi, G., & Marozzi, I. (2024) · Springer eBooks · doi:10.1007/978-3-030-74720-6_29 · Cited by 1
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Picón‐Jaimes, Y. A., Toro-Gómez, D. M., Castillo-Restrepo, M., Sánchez-Estrada, L. F., Cárdenas-Bravo, D. F., Agámez, D. M. A., Gómez-Galán, M. A., Chamorro-Azuaje, T. J., & Salcedo-Pacheco, M. D. C. (2023) · Revista Investigación en Salud Universidad de Boyacá · doi:10.24267/23897325.890 · Cited by 1
Head-up tilt testing in older syncope patients: a systematic review
de Ruiter, S. C., van Marum, R. J., RUITER, J. H., Hemels, M. E. W., de Groot, J. R., & Jansen, R. W. M. M. (2025) · Age and Ageing · doi:10.1093/ageing/afaf086 · Cited by 1
Metadata
- Authors
- Sutton, R., & Brignole, M.
- Affiliations
- Imperial College London (GB)
- Presidio Ospedaliero (IT)
- Corresponding author
- Sutton, R.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-06-30
- Volume
- 35
- Issue
- 33
- Pages
- 2211-2212
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2023173182
- Cited by
- 127
- References
- 22
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 7 · 2023: 11 · 2022: 9 · 2021: 19 · 2020: 14 · 2019: 12 · 2018: 12 · 2017: 10 · 2016: 9 · 2015: 10 · 2014: 5
- FWCI
- 11.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › 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, syncope, vasovagal syncope, cardiac syncope, reflex syncope, pacemaker therapy, sensitivity and specificity, test interpretation
- MeSH terms
- Diagnosis, Differential, Disease Susceptibility, Humans, Hypotension, Sensitivity and Specificity, Syncope, Tilt-Table Test
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