Tilt table testing, methodology and practical insights for the clinic

IF 1.3 4区 医学 Q4 PHYSIOLOGY Clinical Physiology and Functional Imaging Pub Date : 2023-10-15 DOI:10.1111/cpf.12859
Steven van Zanten, Richard Sutton, Viktor Hamrefors, Artur Fedorowski, Frederik J. de Lange
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Abstract

Tilt table testing (TTT) has been used for decades to study short-term blood pressure (BP) and heart rate regulation during orthostatic challenges. TTT provokes vasovagal reflex in many syncope patients as a background of widespread use. Despite the availability of evidence-based practice syncope guidelines, proper application and interpretation of TTT in the day-to-day care of syncope patients remain challenging. In this review, we offer practical information on what is needed to perform TTT, how results should be interpreted including the Vasovagal Syncope International Study classification, why syncope induction on TTT is necessary in patients with unexplained syncope and on indications for TTT in syncope patient care. The minimum requirements to perform TTT are a tilt table with an appropriate tilt-down time, a continuous beat-to-beat BP monitor with at least three electrocardiogram leads and trained staff. We emphasize that TTT remains a valuable asset that adds to history building but cannot replace it, and highlight the importance of recognition when TTT is abnormal even without syncope. Acknowledgement by the patient/eyewitness of the reproducibility of the induced attack is mandatory in concluding a diagnosis. TTT may be indicated when the initial syncope evaluation does not yield a certain, highly likely, or possible diagnosis, but raises clinical suspicion of (1) reflex syncope, (2) orthostatic hypotension (OH), (3) postural orthostatic tachycardia syndrome or (4) psychogenic pseudosyncope. A therapeutic indication for TTT in the patient with a certain, highly likely or possible diagnosis of reflex syncope, may be to educate patients on prodromes. In patients with reflex syncope with OH TTT can be therapeutic to recognize hypotensive symptoms causing near-syncope to perform physical countermanoeuvres for syncope prevention (biofeedback). Detection of hypotensive susceptibility requiring therapy is of special value.

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倾斜台测试、方法和临床实践见解。
几十年来,倾斜台测试(TTT)一直被用于研究直立挑战期间的短期血压(BP)和心率调节。TTT引起许多晕厥患者的血管迷走神经反射,这是广泛使用的背景。尽管有循证实践晕厥指南,但TTT在晕厥患者日常护理中的正确应用和解释仍然具有挑战性。在这篇综述中,我们提供了关于进行TTT需要什么、如何解释结果的实用信息,包括血管迷走性晕厥国际研究分类、为什么不明原因晕厥患者需要在TTT上诱导晕厥,以及TTT在晕厥患者护理中的指征。进行TTT的最低要求是具有适当倾斜时间的倾斜台、具有至少三条心电图导线的连续逐搏血压监测仪和训练有素的工作人员。我们强调TTT仍然是一项宝贵的资产,它增加了历史的构建,但不能取代它,并强调了当TTT异常时,即使没有晕厥,也要进行识别的重要性。在得出诊断结论时,患者/目击者必须确认诱发发作的再现性。当最初的晕厥评估没有得出特定、极有可能或可能的诊断,但引起临床怀疑(1)反射性晕厥、(2)直立性低血压(OH)、(3)体位性直立性心动过速综合征或(4)心因性假性晕厥时,可提示TTT。TTT的一个治疗指征是对某些、极有可能或可能诊断为反射性晕厥的患者进行前驱症状教育。在反射性晕厥患者中,OH-TTT可用于识别引起近晕厥的低血压症状,以进行预防晕厥的物理对策(生物反馈)。检测需要治疗的低血压易感性具有特殊价值。
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来源期刊
CiteScore
3.40
自引率
5.60%
发文量
62
审稿时长
6-12 weeks
期刊介绍: Clinical Physiology and Functional Imaging publishes reports on clinical and experimental research pertinent to human physiology in health and disease. The scope of the Journal is very broad, covering all aspects of the regulatory system in the cardiovascular, renal and pulmonary systems with special emphasis on methodological aspects. The focus for the journal is, however, work that has potential clinical relevance. The Journal also features review articles on recent front-line research within these fields of interest. Covered by the major abstracting services including Current Contents and Science Citation Index, Clinical Physiology and Functional Imaging plays an important role in providing effective and productive communication among clinical physiologists world-wide.
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