Characteristics of head-up tilt testing with additional adenosine compared with head-up tilt testing with isoproterenol and isosorbide dinitrate
Background: Head-up tilt (HUT) testing is used to establish the diagnosis of neurally mediated syncope (NMS). Adenosine administration during HUT testing is useful for inducing NMS. However, no comparison between adenosine HUT testing and HUT testing using other drugs has been reported. The purpose...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2014-12-01
|
| Series: | Journal of Arrhythmia |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1880427614000313 |
| _version_ | 1828887904313671680 |
|---|---|
| author | Norikazu Watanabe, MD Shirou Kawasaki, MD Yoshimi Oonishi, MD Yoshimasa Onuma, MD Yumi Munetsugu, MD Takayuki Itou, MD Tatsuya Onuki, MD Fumito Miyoshi, MD Yoshino Minoura, MD Tarou Adachi, MD Mitsuharu Kawamura, MD Taku Asano, MD Kaoru Tanno, MD Youichi Kobayashi, MD |
| author_facet | Norikazu Watanabe, MD Shirou Kawasaki, MD Yoshimi Oonishi, MD Yoshimasa Onuma, MD Yumi Munetsugu, MD Takayuki Itou, MD Tatsuya Onuki, MD Fumito Miyoshi, MD Yoshino Minoura, MD Tarou Adachi, MD Mitsuharu Kawamura, MD Taku Asano, MD Kaoru Tanno, MD Youichi Kobayashi, MD |
| author_sort | Norikazu Watanabe, MD |
| collection | DOAJ |
| description | Background: Head-up tilt (HUT) testing is used to establish the diagnosis of neurally mediated syncope (NMS). Adenosine administration during HUT testing is useful for inducing NMS. However, no comparison between adenosine HUT testing and HUT testing using other drugs has been reported. The purpose of this study was to investigate the clinical usefulness of adenosine compared with isoproterenol (ISP) and isosorbide (ISDN) during HUT testing.
Methods: The subjects comprised 103 consecutive patients with unexplained syncope who underwent adenosine and isoproterenol (ISP) HUT tests following a negative response in a drug-free HUT test. Subjects were first tilted upright at an 80° angle for 30 min and shown to have a negative response in drug-free HUT test. Subsequently, a continuous bolus of 0.1- or 0.2-mg/kg adenosine was administered while the subjects remained upright and were observed for 5 min (adenosine HUT test). Next, they were tilted upright for 15 min during a continuous infusion of 0.01–0.02 mg/kg min ISP (ISP HUT test). Lastly, they were tilted upright for 15 min after 1.25-mg ISDN infusion (ISDN HUT test).
Results: The diagnostic yield of the adenosine HUT test was 18.1% (18/99) and that of the ISP HUT test was 6.0% (6/99; p=N.S.). Sixty-one of 99 patients underwent ISDN HUT testing, and 17 patients had a positive response. The diagnostic yield of the adenosine HUT test was 14.7% (9/61) and that of ISDN HUT test was 27.8% (p<0.05). Five patients had positive responses in both adenosine and ISDN HUT tests. Conversely, 4 patients had a positive response in the adenosine HUT test and a negative response in the ISDN HUT test.
Conclusion: The adenosine HUT test was effective in the diagnosis of NMS and is useful as the ISP HUT test for inducing NMS. The diagnostic yield of the adenosine HUT test was not higher than that of the ISDN HUT test. However, the adenosine HUT test took only a few minutes and induced NMS in some of the patients in whom NMS was not induced by the ISDN HUT test. Therefore, performing adenosine HUT testing is worthwhile. |
| first_indexed | 2024-12-13T12:12:59Z |
| format | Article |
| id | doaj.art-c8c266b6d40c44a28077fd496646e229 |
| institution | Directory Open Access Journal |
| issn | 1880-4276 |
| language | English |
| last_indexed | 2024-12-13T12:12:59Z |
| publishDate | 2014-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Arrhythmia |
| spelling | doaj.art-c8c266b6d40c44a28077fd496646e2292022-12-21T23:46:48ZengWileyJournal of Arrhythmia1880-42762014-12-0130647347710.1016/j.joa.2014.02.004Characteristics of head-up tilt testing with additional adenosine compared with head-up tilt testing with isoproterenol and isosorbide dinitrateNorikazu Watanabe, MDShirou Kawasaki, MDYoshimi Oonishi, MDYoshimasa Onuma, MDYumi Munetsugu, MDTakayuki Itou, MDTatsuya Onuki, MDFumito Miyoshi, MDYoshino Minoura, MDTarou Adachi, MDMitsuharu Kawamura, MDTaku Asano, MDKaoru Tanno, MDYouichi Kobayashi, MDBackground: Head-up tilt (HUT) testing is used to establish the diagnosis of neurally mediated syncope (NMS). Adenosine administration during HUT testing is useful for inducing NMS. However, no comparison between adenosine HUT testing and HUT testing using other drugs has been reported. The purpose of this study was to investigate the clinical usefulness of adenosine compared with isoproterenol (ISP) and isosorbide (ISDN) during HUT testing. Methods: The subjects comprised 103 consecutive patients with unexplained syncope who underwent adenosine and isoproterenol (ISP) HUT tests following a negative response in a drug-free HUT test. Subjects were first tilted upright at an 80° angle for 30 min and shown to have a negative response in drug-free HUT test. Subsequently, a continuous bolus of 0.1- or 0.2-mg/kg adenosine was administered while the subjects remained upright and were observed for 5 min (adenosine HUT test). Next, they were tilted upright for 15 min during a continuous infusion of 0.01–0.02 mg/kg min ISP (ISP HUT test). Lastly, they were tilted upright for 15 min after 1.25-mg ISDN infusion (ISDN HUT test). Results: The diagnostic yield of the adenosine HUT test was 18.1% (18/99) and that of the ISP HUT test was 6.0% (6/99; p=N.S.). Sixty-one of 99 patients underwent ISDN HUT testing, and 17 patients had a positive response. The diagnostic yield of the adenosine HUT test was 14.7% (9/61) and that of ISDN HUT test was 27.8% (p<0.05). Five patients had positive responses in both adenosine and ISDN HUT tests. Conversely, 4 patients had a positive response in the adenosine HUT test and a negative response in the ISDN HUT test. Conclusion: The adenosine HUT test was effective in the diagnosis of NMS and is useful as the ISP HUT test for inducing NMS. The diagnostic yield of the adenosine HUT test was not higher than that of the ISDN HUT test. However, the adenosine HUT test took only a few minutes and induced NMS in some of the patients in whom NMS was not induced by the ISDN HUT test. Therefore, performing adenosine HUT testing is worthwhile.http://www.sciencedirect.com/science/article/pii/S1880427614000313Head-up tilt testingAdenosineIsoproterenolIsosorbide |
| spellingShingle | Norikazu Watanabe, MD Shirou Kawasaki, MD Yoshimi Oonishi, MD Yoshimasa Onuma, MD Yumi Munetsugu, MD Takayuki Itou, MD Tatsuya Onuki, MD Fumito Miyoshi, MD Yoshino Minoura, MD Tarou Adachi, MD Mitsuharu Kawamura, MD Taku Asano, MD Kaoru Tanno, MD Youichi Kobayashi, MD Characteristics of head-up tilt testing with additional adenosine compared with head-up tilt testing with isoproterenol and isosorbide dinitrate Journal of Arrhythmia Head-up tilt testing Adenosine Isoproterenol Isosorbide |
| title | Characteristics of head-up tilt testing with additional adenosine compared with head-up tilt testing with isoproterenol and isosorbide dinitrate |
| title_full | Characteristics of head-up tilt testing with additional adenosine compared with head-up tilt testing with isoproterenol and isosorbide dinitrate |
| title_fullStr | Characteristics of head-up tilt testing with additional adenosine compared with head-up tilt testing with isoproterenol and isosorbide dinitrate |
| title_full_unstemmed | Characteristics of head-up tilt testing with additional adenosine compared with head-up tilt testing with isoproterenol and isosorbide dinitrate |
| title_short | Characteristics of head-up tilt testing with additional adenosine compared with head-up tilt testing with isoproterenol and isosorbide dinitrate |
| title_sort | characteristics of head up tilt testing with additional adenosine compared with head up tilt testing with isoproterenol and isosorbide dinitrate |
| topic | Head-up tilt testing Adenosine Isoproterenol Isosorbide |
| url | http://www.sciencedirect.com/science/article/pii/S1880427614000313 |
| work_keys_str_mv | AT norikazuwatanabemd characteristicsofheaduptilttestingwithadditionaladenosinecomparedwithheaduptilttestingwithisoproterenolandisosorbidedinitrate AT shiroukawasakimd characteristicsofheaduptilttestingwithadditionaladenosinecomparedwithheaduptilttestingwithisoproterenolandisosorbidedinitrate AT yoshimioonishimd characteristicsofheaduptilttestingwithadditionaladenosinecomparedwithheaduptilttestingwithisoproterenolandisosorbidedinitrate AT yoshimasaonumamd characteristicsofheaduptilttestingwithadditionaladenosinecomparedwithheaduptilttestingwithisoproterenolandisosorbidedinitrate AT yumimunetsugumd characteristicsofheaduptilttestingwithadditionaladenosinecomparedwithheaduptilttestingwithisoproterenolandisosorbidedinitrate AT takayukiitoumd characteristicsofheaduptilttestingwithadditionaladenosinecomparedwithheaduptilttestingwithisoproterenolandisosorbidedinitrate AT tatsuyaonukimd characteristicsofheaduptilttestingwithadditionaladenosinecomparedwithheaduptilttestingwithisoproterenolandisosorbidedinitrate AT fumitomiyoshimd characteristicsofheaduptilttestingwithadditionaladenosinecomparedwithheaduptilttestingwithisoproterenolandisosorbidedinitrate AT yoshinominouramd characteristicsofheaduptilttestingwithadditionaladenosinecomparedwithheaduptilttestingwithisoproterenolandisosorbidedinitrate AT tarouadachimd characteristicsofheaduptilttestingwithadditionaladenosinecomparedwithheaduptilttestingwithisoproterenolandisosorbidedinitrate AT mitsuharukawamuramd characteristicsofheaduptilttestingwithadditionaladenosinecomparedwithheaduptilttestingwithisoproterenolandisosorbidedinitrate AT takuasanomd characteristicsofheaduptilttestingwithadditionaladenosinecomparedwithheaduptilttestingwithisoproterenolandisosorbidedinitrate AT kaorutannomd characteristicsofheaduptilttestingwithadditionaladenosinecomparedwithheaduptilttestingwithisoproterenolandisosorbidedinitrate AT youichikobayashimd characteristicsofheaduptilttestingwithadditionaladenosinecomparedwithheaduptilttestingwithisoproterenolandisosorbidedinitrate |