A Retrospective Chart Review of the Head-Up Tilt Table Test at a Tertiary Care University Hospital

Abstract

Objectives: Syncope is a non-traumatic and self-limiting transient loss of consciousness (TLOC) caused by momentary cerebral hypo-perfusion. It can be classified into orthostatic, cardiac, and vasovagal etiologies, distinguished using the up-tilt table test (HUTT). Our objective was to determine the characteristics of patients undergoing HUTT for TLOC.

Methodology: We conducted a single-center retrospective chart review of patients aged > 16 years who underwent HUTT from January 2010 to March 2020 at the cardiology and neurology departments of Shifa International Hospital, Islamabad, Pakistan. Charts were reviewed for basic demographic data and indications and outcomes of HUTT.

Results: Our study included 496 patients with 72.2% males and a mean age of 51.1 ± 19.08 years. Vasovagal syncope was the most common etiology (79.8%, 158), followed by orthostatic syncope (11.6%, 23), autonomic syncope (6.1%, 12) and postural orthostatic tachycardia syndrome (2.5%, 5). Vasovagal syncope was divided into three subtypes, with the most common being mixed type (82.3%, 130), followed by pure vasodepressor (14.6%, 23) and cardio-inhibitory (3.2%, 5). The two most common prodromal symptoms were loss of consciousness (45.8%, 227) with or without preceding dizziness, followed by dizziness alone (34.5%, 171). Both symptoms had a statistical significance when compared to the diagnostic yield of HUTT testing (p<0.05). No significant correlation (p>0.05) was found between presenting symptoms, age, gender, and HUTT outcomes.

Conclusion: The most common etiology of syncope is vasovagal, predominantly the mixed type. LOC and dizziness were significantly associated with the HUTT yield.