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2017 ; 12
(6
): e0179631
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English Wikipedia
A new test for diagnosing vasovagal syncope: Standing after treadmill test with
sublingual nitrate administration
#MMPMID28617840
Kim TH
; Jang HJ
; Kim S
; Cho SY
; Song KS
; Pickett C
; Schmitt HJ
; Lee J
PLoS One
2017[]; 12
(6
): e0179631
PMID28617840
show ga
INTRODUCTION: Increased adrenergic tone might be an additional trigger of
orthostatic stress of vasovagal syncope (VVS). Exercise before standing might
provide increased sensitivity compared to standing using a sublingual
nitroglycerines protocol during tilt table testing. The aim of this study was to
evaluate the diagnostic value of treadmill testing before standing with
nitroglycerin administration. METHODS AND RESULTS: A total of 36 patients with
syncope or presyncope were enrolled for the test. VVS was confirmed in 29
patients according to the Calgary Score (? -2), including 20 patients who were
likely to have typical (classical) VVS. All 36 subjects were subjected to a novel
provocation test consisting of treadmill test using the Bruce protocol followed
by standing with administration of 300 ?g sublingual nitroglycerin. Consequently,
syncope or presyncope occurred in 22 patients of the 36 patients. The sensitivity
and a specificity of the test for Calgary score based VVS was 82.7% and 85.75%,
respectively. Reproducibility rate for typical VVS was 90% (18 of 20). In all
symptomatic patients, systolic blood pressure dropped to < 90 mmHg and symptom
occurred a mean of 6.7 ± 2.3 minutes after the nitroglycerine administration. No
patient required anticholinergics injection to restore vital signs. CONCLUSIONS:
Treadmill test with administration of sublingual nitroglycerines might be safely
used to reproduce syncope in patients with VVS. More clinical experience and
confirmation are needed to validate this protocol.