Prospective evaluation of high-dose or low-dose isoproterenol upright tilt protocol for unexplained syncope in young adults
The sensitivity of the passive head-up tilt test (HUT) in the evaluation of unexplained short-lasting syncope in young adults remains insufficient. The infusion of isoproterenol was proposed to improve the benefit. To evaluate the sensitivity-specificity relationship during isoproterenol dosing, we...
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| Veröffentlicht in: | The American heart journal 1997-03, Vol.133 (3), p.346-352 |
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| creator | Carlioz, Roland Graux, Pierre Haye, Jerome Letourneau, Thierry Guyomar, Yves Hubert, Edouard Bodart, Jean Christophe Lequeuche, Bruno Burlaton, Jean-Paul |
| description | The sensitivity of the passive head-up tilt test (HUT) in the evaluation of unexplained short-lasting syncope in young adults remains insufficient. The infusion of isoproterenol was proposed to improve the benefit. To evaluate the sensitivity-specificity relationship during isoproterenol dosing, we studied 76 young adults (aged 20.9 ± 1.7 years) (group S) with recurrent (mean 3.8 ± 1.6) losses of consciousness that remained unexplained after clinical and noninvasive assessment and 35 young healthy volunteers (aged 22.6 ± 2.7 years) (group V). Subjects underwent either passive HUT (45 min, 60 degrees without drug dosing for 48 subjects in group S (S1) and 17 in group V (V1), or HUT with isoproterenol infusion at progressive doses (2 then 5 μg/min) after 30 minutes of passive tilting for 28 patients in group S (S2) and 18 in group V (V2). During passive HUT, the test was positive (asystole, bradycardia, or fall in systolic blood pressure) in 2 of 17 (11.8%) patients in group V1 and in 7 of 48 (14.6%) in group S1 before 30 minutes, and in 3 of 17 (17.6%) in group V1 compared with 10 of 48 (20.8%) in group S1 at the end of the 45-minute infusion, with no difference in delay before the appearance of a positive result. During HUT with isoproterenol dosing, the test was positive in 2 of 18 (11.1%) patients in group V2 and in 18 of 28 (64.2%) in group S2 before 45 minutes (2 μg/min;
p < 0.01) in 7 of 18 (38.8%) in group V2 compared with 24 of 28 (85.7%) in group S2 before 60 min (5 μg/min;
p < 0.01). In both cases the mean delay in evoking a positive response was significantly shorter. No asystolic response was observed in the volunteers regardless of the protocol used. The most characteristic response to isoproterenol injection was the appearance of a junctional escape rate with a fall in systolic blood pressure (61.5% of subjects in group S2). The infusion of isoproterenol considerably improves the sensitivity of the HUT with satisfactory specificity if low doses are used ( |
| doi_str_mv | 10.1016/S0002-8703(97)70231-X |
| format | Article |
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p < 0.01) in 7 of 18 (38.8%) in group V2 compared with 24 of 28 (85.7%) in group S2 before 60 min (5 μg/min;
p < 0.01). In both cases the mean delay in evoking a positive response was significantly shorter. No asystolic response was observed in the volunteers regardless of the protocol used. The most characteristic response to isoproterenol injection was the appearance of a junctional escape rate with a fall in systolic blood pressure (61.5% of subjects in group S2). The infusion of isoproterenol considerably improves the sensitivity of the HUT with satisfactory specificity if low doses are used (<3 μg/min). These results support the use of HUT with isoproterenol in the evaluation of unexplained syncope in young adults. (Am Heart J 1997; 133:346-52.)</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/S0002-8703(97)70231-X</identifier><identifier>PMID: 9060805</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adrenergic beta-Agonists - administration & dosage ; Adult ; Biological and medical sciences ; Evaluation Studies as Topic ; Female ; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy ; Hemodynamics ; Humans ; Isoproterenol - administration & dosage ; Male ; Medical sciences ; Nervous system (semeiology, syndromes) ; Neurology ; Prospective Studies ; Sensitivity and Specificity ; Space life sciences ; Syncope - diagnosis ; Syncope - physiopathology ; Tilt-Table Test</subject><ispartof>The American heart journal, 1997-03, Vol.133 (3), p.346-352</ispartof><rights>1997 Mosby, Inc.</rights><rights>1997 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c455t-25c8888438ec239273e6b9880aa37f176e4403d236d122754c77ff49371669403</citedby><cites>FETCH-LOGICAL-c455t-25c8888438ec239273e6b9880aa37f176e4403d236d122754c77ff49371669403</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S000287039770231X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27903,27904,65309</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2654094$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9060805$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Carlioz, Roland</creatorcontrib><creatorcontrib>Graux, Pierre</creatorcontrib><creatorcontrib>Haye, Jerome</creatorcontrib><creatorcontrib>Letourneau, Thierry</creatorcontrib><creatorcontrib>Guyomar, Yves</creatorcontrib><creatorcontrib>Hubert, Edouard</creatorcontrib><creatorcontrib>Bodart, Jean Christophe</creatorcontrib><creatorcontrib>Lequeuche, Bruno</creatorcontrib><creatorcontrib>Burlaton, Jean-Paul</creatorcontrib><title>Prospective evaluation of high-dose or low-dose isoproterenol upright tilt protocol for unexplained syncope in young adults</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>The sensitivity of the passive head-up tilt test (HUT) in the evaluation of unexplained short-lasting syncope in young adults remains insufficient. The infusion of isoproterenol was proposed to improve the benefit. To evaluate the sensitivity-specificity relationship during isoproterenol dosing, we studied 76 young adults (aged 20.9 ± 1.7 years) (group S) with recurrent (mean 3.8 ± 1.6) losses of consciousness that remained unexplained after clinical and noninvasive assessment and 35 young healthy volunteers (aged 22.6 ± 2.7 years) (group V). Subjects underwent either passive HUT (45 min, 60 degrees without drug dosing for 48 subjects in group S (S1) and 17 in group V (V1), or HUT with isoproterenol infusion at progressive doses (2 then 5 μg/min) after 30 minutes of passive tilting for 28 patients in group S (S2) and 18 in group V (V2). During passive HUT, the test was positive (asystole, bradycardia, or fall in systolic blood pressure) in 2 of 17 (11.8%) patients in group V1 and in 7 of 48 (14.6%) in group S1 before 30 minutes, and in 3 of 17 (17.6%) in group V1 compared with 10 of 48 (20.8%) in group S1 at the end of the 45-minute infusion, with no difference in delay before the appearance of a positive result. During HUT with isoproterenol dosing, the test was positive in 2 of 18 (11.1%) patients in group V2 and in 18 of 28 (64.2%) in group S2 before 45 minutes (2 μg/min;
p < 0.01) in 7 of 18 (38.8%) in group V2 compared with 24 of 28 (85.7%) in group S2 before 60 min (5 μg/min;
p < 0.01). In both cases the mean delay in evoking a positive response was significantly shorter. No asystolic response was observed in the volunteers regardless of the protocol used. The most characteristic response to isoproterenol injection was the appearance of a junctional escape rate with a fall in systolic blood pressure (61.5% of subjects in group S2). The infusion of isoproterenol considerably improves the sensitivity of the HUT with satisfactory specificity if low doses are used (<3 μg/min). These results support the use of HUT with isoproterenol in the evaluation of unexplained syncope in young adults. (Am Heart J 1997; 133:346-52.)</description><subject>Adrenergic beta-Agonists - administration & dosage</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Evaluation Studies as Topic</subject><subject>Female</subject><subject>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Isoproterenol - administration & dosage</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Prospective Studies</subject><subject>Sensitivity and Specificity</subject><subject>Space life sciences</subject><subject>Syncope - diagnosis</subject><subject>Syncope - physiopathology</subject><subject>Tilt-Table Test</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkV9vFCEUxYnR1LX6EZrwYIw-jPJvYHgypmnVpIlN1KRvhDJ3WgwLIzCrG7982e5mX-UFuOccuPxA6IyS95RQ-eE7IYR1gyL8rVbvFGGcdjdP0IoSrTqphHiKVkfLc_SilF9tK9kgT9CJJpIMpF-hf9c5lRlc9RvAsLFhsdWniNOE7_3dfTemAjhlHNKf_dqXNOdUIUNMAS9zbq6Kqw8V7-rJterUAkuEv3OwPsKIyza6NLdsxNu0xDtsxyXU8hI9m2wo8Oown6Kflxc_zr90V98-fz3_dNU50fe1Y70b2hB8AMe4ZoqDvNXDQKzlaqJKghCEj4zLkTKmeuGUmiahuaJS6iadojf7c1uDvxco1ax9cRCCjZCWYtQwyMalb8Z-b3QNSskwmfa8tc1bQ4nZQTeP0M2OqNHKPEI3Ny13drhguV3DeEwdKDf99UG3xdkwZRudL0cbk70gWjTbx70NGoyNh2yK8xAdjD63HzJj8v9p5AGN65-b</recordid><startdate>19970301</startdate><enddate>19970301</enddate><creator>Carlioz, Roland</creator><creator>Graux, Pierre</creator><creator>Haye, Jerome</creator><creator>Letourneau, Thierry</creator><creator>Guyomar, Yves</creator><creator>Hubert, Edouard</creator><creator>Bodart, Jean Christophe</creator><creator>Lequeuche, Bruno</creator><creator>Burlaton, Jean-Paul</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19970301</creationdate><title>Prospective evaluation of high-dose or low-dose isoproterenol upright tilt protocol for unexplained syncope in young adults</title><author>Carlioz, Roland ; Graux, Pierre ; Haye, Jerome ; Letourneau, Thierry ; Guyomar, Yves ; Hubert, Edouard ; Bodart, Jean Christophe ; Lequeuche, Bruno ; Burlaton, Jean-Paul</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c455t-25c8888438ec239273e6b9880aa37f176e4403d236d122754c77ff49371669403</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Adrenergic beta-Agonists - administration & dosage</topic><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Evaluation Studies as Topic</topic><topic>Female</topic><topic>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Isoproterenol - administration & dosage</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Prospective Studies</topic><topic>Sensitivity and Specificity</topic><topic>Space life sciences</topic><topic>Syncope - diagnosis</topic><topic>Syncope - physiopathology</topic><topic>Tilt-Table Test</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Carlioz, Roland</creatorcontrib><creatorcontrib>Graux, Pierre</creatorcontrib><creatorcontrib>Haye, Jerome</creatorcontrib><creatorcontrib>Letourneau, Thierry</creatorcontrib><creatorcontrib>Guyomar, Yves</creatorcontrib><creatorcontrib>Hubert, Edouard</creatorcontrib><creatorcontrib>Bodart, Jean Christophe</creatorcontrib><creatorcontrib>Lequeuche, Bruno</creatorcontrib><creatorcontrib>Burlaton, Jean-Paul</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Carlioz, Roland</au><au>Graux, Pierre</au><au>Haye, Jerome</au><au>Letourneau, Thierry</au><au>Guyomar, Yves</au><au>Hubert, Edouard</au><au>Bodart, Jean Christophe</au><au>Lequeuche, Bruno</au><au>Burlaton, Jean-Paul</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prospective evaluation of high-dose or low-dose isoproterenol upright tilt protocol for unexplained syncope in young adults</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>1997-03-01</date><risdate>1997</risdate><volume>133</volume><issue>3</issue><spage>346</spage><epage>352</epage><pages>346-352</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>The sensitivity of the passive head-up tilt test (HUT) in the evaluation of unexplained short-lasting syncope in young adults remains insufficient. The infusion of isoproterenol was proposed to improve the benefit. To evaluate the sensitivity-specificity relationship during isoproterenol dosing, we studied 76 young adults (aged 20.9 ± 1.7 years) (group S) with recurrent (mean 3.8 ± 1.6) losses of consciousness that remained unexplained after clinical and noninvasive assessment and 35 young healthy volunteers (aged 22.6 ± 2.7 years) (group V). Subjects underwent either passive HUT (45 min, 60 degrees without drug dosing for 48 subjects in group S (S1) and 17 in group V (V1), or HUT with isoproterenol infusion at progressive doses (2 then 5 μg/min) after 30 minutes of passive tilting for 28 patients in group S (S2) and 18 in group V (V2). During passive HUT, the test was positive (asystole, bradycardia, or fall in systolic blood pressure) in 2 of 17 (11.8%) patients in group V1 and in 7 of 48 (14.6%) in group S1 before 30 minutes, and in 3 of 17 (17.6%) in group V1 compared with 10 of 48 (20.8%) in group S1 at the end of the 45-minute infusion, with no difference in delay before the appearance of a positive result. During HUT with isoproterenol dosing, the test was positive in 2 of 18 (11.1%) patients in group V2 and in 18 of 28 (64.2%) in group S2 before 45 minutes (2 μg/min;
p < 0.01) in 7 of 18 (38.8%) in group V2 compared with 24 of 28 (85.7%) in group S2 before 60 min (5 μg/min;
p < 0.01). In both cases the mean delay in evoking a positive response was significantly shorter. No asystolic response was observed in the volunteers regardless of the protocol used. The most characteristic response to isoproterenol injection was the appearance of a junctional escape rate with a fall in systolic blood pressure (61.5% of subjects in group S2). The infusion of isoproterenol considerably improves the sensitivity of the HUT with satisfactory specificity if low doses are used (<3 μg/min). These results support the use of HUT with isoproterenol in the evaluation of unexplained syncope in young adults. (Am Heart J 1997; 133:346-52.)</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>9060805</pmid><doi>10.1016/S0002-8703(97)70231-X</doi><tpages>7</tpages></addata></record> |
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| subjects | Adrenergic beta-Agonists - administration & dosage Adult Biological and medical sciences Evaluation Studies as Topic Female Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Hemodynamics Humans Isoproterenol - administration & dosage Male Medical sciences Nervous system (semeiology, syndromes) Neurology Prospective Studies Sensitivity and Specificity Space life sciences Syncope - diagnosis Syncope - physiopathology Tilt-Table Test |
| title | Prospective evaluation of high-dose or low-dose isoproterenol upright tilt protocol for unexplained syncope in young adults |
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