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Comparison of provocative tests for unexplained syncope: isoprenaline and glyceryl trinitrate for diagnosing vasovagal syncope

Lookup NU author(s): Dr Laura Graham, Dr Janine Gray, Professor Rose Anne Kenny

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Abstract

Aims To compare the sensitivity, specificity and adverse event profile of glyceryl trinitrate head-up tilt with isoprenaline head-up tilt in the diagnosis of vasovagal syncope in patients with unexplained syncope and healthy controls Methods and Results Forty-eight patients with unexplained syncope and negative passive head-up tilt at 70 degrees for 40 min, and 14 healthy controls underwent glyceryl trinitrate head-up tilt and isoprenaline head-up tilt (maximum dose 5 mug . min(-1)) one week apart in random order. Outcome measures were production of symptoms (syncope, pre-syncope) with development of hypotension. In those with negative passive head-up till, the sensitivity of glyceryl trinitrate for diagnosing vasovagal syncope was 48% and the specificity was 71%. Glyceryl trinitrate was well tolerated. Isoprenaline sensitivity was 21% with specificity 64%. Side-effects prevented completion of the test in 68%. Commonest adverse events were the development of hypertension or tachycardia and intolerable flushing or nausea. Conclusions Glyceryl trinitrate head-up tilt is as effective as isoprenaline head-up tilt as a provocative agent for vasovagal syncope and has a lower incidence of adverse events (C) 2001 The European Society of Cardiology.

Publication metadata

Author(s): Kenny RA; Gray JC; Graham LA

Publication type: Article

Publication status: Published

Journal: European Heart Journal

Year: 2001

Volume: 22

Issue: 6

Pages: 497-503

ISSN (print): 0195-668X

ISSN (electronic): 1522-9645

Publisher: Oxford University Press

URL: http://dx.doi.org/10.1053/euhj.1999.2007

DOI: 10.1053/euhj.1999.2007

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