Hostname: page-component-848d4c4894-nr4z6 Total loading time: 0 Render date: 2024-06-09T18:09:24.890Z Has data issue: false hasContentIssue false
  • English
  • Français

Tilt angles and positive response of head-up tilt test in children with orthostatic intolerance

Published online by Cambridge University Press:  15 October 2013

Jing Lin ,
Yuli Wang ,
Todd Ochs ,
Chaoshu Tang ,
Junbao Du  and
Hongfang Jin
Jing Lin
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China
Yuli Wang
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China
Todd Ochs
Affiliation:
Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States of America
Chaoshu Tang
Affiliation:
Department of Physiology and Pathophysiology, Peking University Health Science Center, Beijing, China Key Lab. of Molecular Cardiology, Ministry of Education, Beijing, China
Junbao Du
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China
Hongfang Jin*
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China
*
Correspondence to: Professors J. Du and H. Jin, Department of Pediatrics, Peking University First Hospital, Beijing 100034, China. Tel: +8610-83573238; Fax: +8610-66530532; E-mails: Junbaodul@126.com, jinhongfang51@126.com
Get access Rights & Permissions [Opens in a new window]

Abstract

This study aimed at examining three tilt angle-based positive responses and the time to positive response in a head-up tilt test for children with orthostatic intolerance, and the psychological fear experienced at the three angles during head-up tilt test. A total of 174 children, including 76 boys and 98 girls, aged from 4 to 18 years old (mean 11.3±2.8 years old), with unexplained syncope, were randomly divided into three groups, to undergo head-up tilt test at the angles of 60°, 70° and 80°, respectively. The diagnostic rates and times were analysed, and Wong–Baker face pain rating scale was used to access the children’s psychological fear. There were no significant differences in diagnostic rates of postural orthostatic tachycardia syndrome and vasovagal syncope at different tilt angles during the head-up tilt test (p>0.05). There was a significant difference, however, in the psychological fear at different tilt angles utilising the Kruskal–Wallis test (χ2=36.398, p<0.01). It was mildest at tilt angle 60° utilising the Kolmogorov–Smirnov test (p<0.01). A positive rank correlation was found between the psychological fear and the degree of tilt angle (rs=0.445, p<0.01). Positive response appearance time was 15.1±14.0 minutes at 60° for vasovagal syncope children. There was no significant difference in the time to positive response, at different tilt angles during the head-up tilt test for vasovagal syncope or for postural orthostatic tachycardia syndrome. Hence, it is suggested that a tilt angle of 60° and head-up tilt test time of 45 minutes should be suitable for children with vasovagal syncope.

Keywords

Head-up tilt testdiagnostic ratedegree of psychological fearpositive response appearance time
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 1 , January 2015 , pp. 76 - 80
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Brignole, M, Hamdan, MH. New concepts in the assessment of syncope. J Am Coll Cardiol 2012; 59: 1583–1591.Google Scholar
2. Yang, J, Zhu, L, Chen, S, et al. Modified Calgary score in differential diagnosis between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope in children. Cardiol Young 2013; 23: 400–404.Google Scholar
3. Chen, L, Zhang, Q, Ingrid, S, et al. Aetiologic and clinical characteristics of syncope in Chinese children. Acta Paediatr 2007; 96: 1505–1510.Google Scholar
4. Lai, WT, Chen, MR, Lin, SM, et al. Application of head-up tilt table testing in children. J Formos Med Assoc 2010; 109: 641–646.CrossRefGoogle ScholarPubMed
5. Chen, L, Wang, C, Wang, H, et al. Underlying diseases in syncope of children in China. Med Sci Monit 2011; 17: H49–H53.Google Scholar
6. Liao, Y, Chen, S, Liu, X, et al. Flow-mediated vasodilation and endothelium function in children with postural orthostatic tachycardia syndrome. Am J Cardiol 2010; 106: 378–382.Google Scholar
7. Chen, L, Yang, YY, Wang, C, et al. A multi-center study of hemodynamic characteristics exhibited by children with unexplained syncope. Chin Med J 2006; 119: 2062–2068.CrossRefGoogle ScholarPubMed
8. Baron-Esquivias, G, Pedrote, A, Cayuela, A, et al. Long-term outcome of patients with asystole induced by head-up tilt test. Eur Heart J 2002; 23: 483–489.Google Scholar
9. Sheldon, R, Koshman, ML. A randomized study of tilt test angle in patients with undiagnosed syncope. Can J Cardiol 2001; 17: 1051–1057.Google Scholar
10. Rosales-Velderrain, A, Cardno, M, Mateus, J, et al. Toe blood pressure and leg muscle oxygenation with body posture. Aviat Space Environ Med 2011; 82: 531–534.Google Scholar
11. Sheldon, R, Sexton, E, Koshman, ML. Usefulness of clinical factors in predicting outcomes of passive tilt tests in patients with syncope. Am J Cardiol 2000; 85: 360–364.Google Scholar
12. Zhang, Q, Zhu, L, Wang, C, et al. Value of history taking in children and adolescents with cardiac syncope. Cardiol Young 2013; 23: 54–60.Google Scholar
13. Zhang, Q, Du, J, Wang, C, et al. The diagnostic protocol in children and adolescents with syncope: a multi-centre prospective study. Acta Paediatr 2009; 98: 879–884.CrossRefGoogle ScholarPubMed
14. Zhang, F, Li, X, Ochs, T, et al. Midregional pro-adrenomedullin as a predictor for therapeutic response to midodrine hydrochloride in children with postural orthostatic tachycardia syndrome. J Am Coll Cardiol 2012; 60: 315–320.CrossRefGoogle ScholarPubMed
15. Freeman, R, Wieling, W, Axelrod, FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011; 21: 69–72.Google Scholar
16. Chinese Pediatric Cardiology Society and the Editorial Board of Chinese Journal of Pediatrics. Guidelines for diagnosis of syncope in children. Zhonghua Er Ke Za Zhi 2009; 47: 99–101.Google Scholar
17. Cravero, JP, Fanciullo, GJ, Mchugo, GJ, et al. The validity of the Computer Face Scale for measuring pediatric pain and mood. Paediatr Anaesth 2013; 23: 156–161.Google Scholar
18. Garra, G, Singer, AJ, Taira, BR, et al. Validation of the Wong–Baker FACES Pain Rating Scale in pediatric emergency department patients. Acad Emerg Med 2010; 17: 50–54.Google Scholar
19. Tomlinson, D, von Baeyer, CL, Stinson, JN, et al. A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics 2010; 126: e1168–e1198.Google Scholar
20. Kikushima, S, Kobayashi, Y, Nakagawa, H, et al. Triggering mechanism for neurally mediated syncope induced by head-up tilt test: role of catecholamines and response to propranolol. J Am Coll Cardiol 1999; 33: 350–357.Google Scholar
21. Blanc, JJ. Clinical laboratory testing: what is the role of tilt-table testing, active standing test, carotid massage, electrophysiological testing and ATP test in the syncope evaluation? Prog Cardiovasc Dis 2013; 55: 418–424.CrossRefGoogle ScholarPubMed
22. Wang, C, Li, W, Wu, L, et al. Clinical characteristics and treatment of 89 patients with head-up tilt table test induced syncope with convulsion. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2013; 38: 70–73.Google Scholar
23. Forleo, C, Guida, P, Iacoviello, M, et al. Head-up tilt testing for diagnosing vasovagal syncope: a meta-analysis. Int J Cardiol 2013; [Epub ahead of print].Google Scholar
24. Voice, RA, Lurie, KG, Sakaguchi, S, et al. Comparison of tilt angles and provocative agents (edrophonium and isoproterenol) to improve head-upright tilt-table testing. Am J Cardiol 1998; 81: 346–351.Google Scholar
25. Lewis, DA, Zlotocha, J, Henke, L, et al. Specificity of head-up tilt testing in adolescents: effect of various degrees of tilt challenge in normal control subjects. J Am Coll Cardiol 1997; 30: 1057–1060.Google Scholar
26. Zaidi, A, Benitez, D, Gaydecki, PA, et al. Haemodynamic effects of increasing angle of head up tilt. Heart 2000; 83: 181–184.Google Scholar
27. Duplyakov, D, Golovina, G, Sysuenkova, E, et al. Can the result of a tilt test be predicted in the first five minutes? Cardiol J 2011; 18: 521–526.CrossRefGoogle ScholarPubMed
28. Liu, J, Fang, P, Liu, Y, et al. Duration of head-up tilt test for patients with suspected vasovagal syncope. Europace 2011; 13: 576–580.Google Scholar
29. Khurana, RK, Nicholas, EM. Head-up tilt table test: how far and how long? Clin Auton Res 1996; 6: 335–341.Google Scholar