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Cited by 85Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlVestibular and auditory disorders

The normal response to prolonged passive head up tilt testing

Open access
Petersen, M E V, Williams, T R, Gordon, C, Chamberlain-Webber, R, Sutton, R·2000·Heart
DOI 10.1136/heart.84.5.509PMC PMC1729464
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Abstract

OBJECTIVE: To define the responses to head up tilt in a large group of normal adult subjects using the most widely employed protocol for tilt testing. METHODS: 127 normal subjects aged 19-88 years (mean (SD), 49 (20) years) without a previous history of syncope underwent tilt testing at 60 degrees for 45 minutes or until syncope intervened. Blood pressure monitoring was performed with digital photoplethysmography, providing continuous, non-invasive, beat to beat heart rate and pressure measurements. RESULTS: 13% of subjects developed vasovagal syncope after a mean (SD) tilt time of 31.7 (12. 4) minutes (range 8.5-44.9 minutes). Severe cardioinhibition during syncope was observed less often than is reported in patients investigated for syncope. There were no differences in the age or sex distributions of subjects with positive or negative outcomes, or in the proportions with cardioinhibitory and vasodepressor vasovagal syncope compared with previously reported patient populations. Subjects with negative outcomes showed age related differences in heart rate and blood pressure behaviour throughout tilt. CONCLUSIONS: False positive results with tilting appear to be common. This has important implications for the use of diagnostic tilt testing. The magnitude of the heart rate and blood pressure changes observed during negative tilts largely invalidates previously suggested criteria for abnormal non-syncopal outcomes.

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  • Tilt testing was positive in 51-56% of patients with atypical clinical features suggesting a reflex mechanism.

    “Indeed, tilt testing was positive in 51-56% of patients with atypical clinical features suggesting a reflex mechanism, 106,124-128”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [125]

    The SUBJECTS discussion (page unavailable) reports positive vasovagal outcomes in 24–75% of patients with unexplained syncope in earlier studies. It does not give a 51–56% rate or identify those patients as having atypical clinical features suggesting a reflex mechanism. The paper’s own Results concern normal subjects, with a 13% positive rate. (LLM, conf=0.78)

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  • Tilt testing has an acceptable sensitivity and specificity when calculated in patients with true VVS or without a history of syncope.

    “Tilt testing has an acceptable sensitivity 124 and specificity 106,124,125 when these are calculated in patients with true VVS or without a history of syncope.”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [125]

    The Discussion reports a 13% vasovagal response rate in people without a history of syncope, providing evidence relevant to specificity. The Subjects section says this implies lower specificity than previously assumed, while the Conclusions caution that false positives are important. The paper does not establish sensitivity in patients with confirmed VVS or characterize both measures as acceptable. (LLM, conf=0.85)

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Cites

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Research works printed but not linked: 4

  1. Graybiel A, McFarland RA. The use of the tilt table test in aviation medicine. J Aviat Med 1941;12:194-211.
  2. Cheng TO. Need for standardisation of tilt-table test evalu- ation of syncope. Am J Cardiol 1992;69:1639.
  3. Petersen MEV, Williams T, Sutton R. A prospective evalua- tion of tilt test outcomes using continuous non-invasive beat-to-beat blood pressure and heart rate monitoring [abstract]. Eur J Cardiac Pacing Electrophysiol 1994;4:150.
  4. Epstein RH, Bartkowski RR, HuYngdale S. Continuous noninvasive finger blood pressure during controlled hypotension. Anaesthesiology 1991;75:796-803.

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Authors
Petersen, M. E. V., Williams, T. R., Gordon, C., Chamberlain-Webber, R., & Sutton, R.
Affiliations
Chelsea and Westminster Hospital (GB)
Corresponding author
Petersen, M E V
ORCID
Sutton, R
Venue
Heart
Publisher
BMJ
Published
2000-11-01
Volume
84
Issue
5
Pages
509-514
ISSN
  • 1355-6037 (ISSN-L)
  • 1468-201X
DOI
10.1136/heart.84.5.509
PMC
PMC1729464
OpenAlex
W2089870967
Cited by
85
References
53
Citations by year
2026: 1 · 2025: 3 · 2024: 1 · 2023: 3 · 2022: 1 · 2021: 6 · 2020: 5 · 2019: 1 · 2018: 5 · 2017: 7 · 2016: 2 · 2015: 6 · 2014: 2 · 2013: 6 · 2012: 2
FWCI
2.16
Type
journal article
Language
en
Open access
Locations
  • Heart (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
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
head-up tilt, vasovagal syncope, cardioinhibition, reference values, blood pressure response, heart rate response, age differences, syncope diagnosis
MeSH terms
Adult, Aged, Aged, 80 and over, Aging, Blood Pressure, False Positive Reactions, Female, Heart Rate, Humans, Hypotension, Orthostatic, Male, Middle Aged, Posture, Reference Values, Tilt-Table Test, Syncope, Vasovagal

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