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CLINICAL STUDIES

Utility of a single-stage isoproterenol tilt table test in adults

A randomized comparison with passive head-up tilt

Win-Kuang Shen, MD, FACC^*, Arshad Jahangir, MD^*, Douglas Beinborn, RN^*, Christine M. Lohse, BS, David O. Hodge, MS, Robert F. Rea, MD, FACC^* and Stephen C. Hammill, MD, FACC^*

^* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

Manuscript received June 11, 1998; revised manuscript received September 16, 1998, accepted December 4, 1998.

Reprint requests and correspondence: Dr. Win-Kuang Shen, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905

OBJECTIVES

This study was conducted to develop a time-efficient tilt table test.

BACKGROUND

Current protocols of tilt table testing are quite time-consuming. This study was designed to assess the diagnostic value, tolerance and procedural time of a single-stage isoproterenol tilt table protocol.

METHODS

A single-stage isoproterenol tilt table test was compared with the passive tilt table test. The study was prospectively designed in a randomized and crossover fashion.

RESULTS

The study population consisted of 111 patients with a history of syncope (mean age 55 ± 20 years). Of the total, 62 patients (56%; 95% confidence interval, 46% to 65%) had a positive vasovagal response during isoproterenol tilt table testing and 35 (32%; 23% to 41%) during passive tilt table testing (p = 0.002). The mean procedural times of the study population were 11.7 ± 3.6 min and 36.9 ± 13.3 min for isoproterenol and passive tilt table testing, respectively (p < 0.001). All patients tolerated single-stage isoproterenol testing. In the 23 control subjects (mean age 34 ± 11 years), the apparent specificities were 91% (72% to 99%) and 83% (61% to 99%) for passive and single-stage tilt table testing, respectively.

CONCLUSIONS

The single-stage isoproterenol tilt table test was more effective in inducing a positive vasovagal response in an adult population than the standard passive tilt table test, and it significantly reduced the procedural time. The increase in positive yield was associated with a moderate decrease in apparent specificity. These observations support the conclusion that single-stage tilt table testing could be a reasonable diagnostic option in patients undergoing syncope evaluation.

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