Long-Term Follow-Up of Patients with Syncope Evaluated by Head-Up Tilt Test


  • Author Disclosures: The authors declare no financial support or affiliations with commercial organizations.

  • Funding: None.

Address for correspondence: Giuseppe Boriani, M.D., Ph.D., Institute of Cardiology, University of Bologna, Azienda Ospedaliera S. Orsola-Malpighi, Bologna, Via Massarenti 9, 40138 Bologna, Italy. Fax: +39-051-349859; E-mail: giuseppe.boriani@unibo.it


Background: Clinicians may be tempted to consider a positive head-up tilt test (HUTT) an unfavorable prognostic indicator. We investigated whether results of routine HUTT predict long-term recurrence of syncope.

Methods: We analyzed syncope recurrence at long-term among 107 patients (mean age 51 ± 20 years) receiving HUTT for diagnostic evaluation of unexplained/suspected neurocardiogenic syncope in our Institute.

Results: HUTT was positive in 76 patients (vasodepressive response, n = 58; cardioinhibitory, n = 5; mixed, n = 13). During a median follow-up of 113 months (range, 7–161), 34 (32%) patients experienced recurrence (24 [32%] with positive HUTT during 110 months (7–159); 10 [32%] with negative HUTT during 120 [22–161] months). Actuarial freedom from recurrence at 10 years did not significantly differ for patients with positive/negative test results (after passive/active phases) or with different positive response patterns (vasodepressive, cardioinhibitory, mixed). By contrast, history of >4 syncopes in the 12 months preceding HUTT stratified risk of recurrence, irrespective of HUTT positivity/negativity. At Cox proportional hazards analysis, history of >4 syncopes in the 12 months preceding HUTT was the single independent risk factor for recurrence both in the overall study population (HR, 1.7; 95% CI, 1.07–2.69) and within the subset of patients who tested positive (HR, 1.83; 95% CI, 1.07–3.17).

Conclusions: This long-term follow-up study reinforces the concept that a positive HUTT should not be considered an unfavorable prognostic indicator; frequency of recent occurrences may be a more valid predictor.

Ann Noninvasive Electrocardiol 2010;15(2):101–106