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Stefano Favale - One of the best experts on this subject based on the ideXlab platform.
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Prevalence, timing, and haemodynamic correlates of prodromes in patients with vasovagal syncope induced by head-up Tilt Test.
Europace, 2009Co-Authors: Pietro Guida, Cataldo Balducci, Margherita Sarlo, Sandro Sorrentino, Cinzia Forleo, Massimo Iacoviello, Angela Ferrara, Stefano FavaleAbstract:Aims To evaluate the prevalence, timing, and haemodynamic characteristics of prodromal symptoms in patients experiencing vasovagal syncope (VVS) during a head-up Tilt Test (HUT) potentiated with nitroglycerin, and their relationships with those reported before spontaneous episodes. Methods and results Symptoms preceding HUT-induced syncope were recorded, together with heart rate (HR) and arterial blood pressure (BP) values, in 149 otherwise healthy and drug-free subjects with recurrent unexplained syncope. Head-up Tilt Test significantly increase the number of patients capable of recognizing the premonitory symptoms of VVS than before spontaneous episodes (96 vs. 79%; P < 0.001). The nine most frequent symptoms were stratified into three groups on the basis of their characteristics: headache, hot flashes, and palpitations occurred more than 3 min before syncope, with a very slight reduction in BP; nausea, asthenia, diaphoresis, vertigo, and epigastric discomfort preceded syncope by 1–3 min and were associated with a slight reduction in BP; and blurred vision appeared the last minute before syncope and was characterized by the lowest BP and HR values. Conclusion In comparison with spontaneous syncopal episodes, HUT allows the more frequent recognition of prodromes also providing useful information in terms of timing and haemodynamic characteristics of symptoms that may allow more tailored patient counselling.
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Endothelin system polymorphisms in Tilt Test-induced vasovagal syncope
Clinical Autonomic Research, 2009Co-Authors: Sandro Sorrentino, Cinzia Forleo, Massimo Iacoviello, Pietro Guida, Valentina D’andria, Stefano FavaleAbstract:Introduction Genetics may be involved in the pathophysiology of vasovagal syncope. The 3A/4A polymorphism of the EDN1 gene affects the expression of endothelin-1, and the H323H T/C polymorphism of the EDNRA gene encoding for the endothelin type A receptor has been associated with cardiovascular pathologies. As the endothelin system participates in the regulation of cardiovascular homeostasis, the aim of this study was to analyse the role of these genetic variants in influencing Tilt-induced vasovagal syncope. Materials and methods We recorded the cardiovascular parameters of 107 otherwise healthy subjects with recurrent unexplained syncope who underwent a head-up Tilt Test; 58 (54%) fainted. Results In terms of the EDNRA polymorphism, eight subjects (8%) had the T/T genotype, 41 were heterozygous (38%) and 58 homozygous (54%) for the C allele. Sixty subjects (56%) carried homozygosis for the 3A allele of the EDN1 polymorphism and 47 were heterozygous (44%). The 4A allele was significantly more frequent in the patients who responded positively to the Tilt Test than in those who did not: the relative odds ratios and confidence intervals at univariate and multivariate analyses were respectively 2.37 (1.07–5.26) and 2.41 (1.05–5.49). Comparisons with a control group further supported these data. Among the Tilt-positive patients, the carriers of the 4A allele were more likely to have a vasodepressive pattern than those who were homozygous for the 3A variant. Conclusion In conclusion, the 3A/4A polymorphism of the EDN1 gene affects susceptibility to syncope, and the 4A variant associated with increased endothhelin-1 expression may promote vasodepressive hemodynamic responses during Tilt Testing.
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Endothelin system polymorphisms in Tilt Test-induced vasovagal syncope
Clinical Autonomic Research, 2009Co-Authors: Sandro Sorrentino, Cinzia Forleo, Massimo Iacoviello, Pietro Guida, Valentina D’andria, Stefano FavaleAbstract:Objectives As the endothelin system participates in the regulation of cardiovascular homeostasis, the aim of this study was to analyse the role of endothelin system polymorphisms in influencing Tilt-induced vasovagal syncope. Methods We evaluated 107 otherwise healthy subjects with recurrent unexplained syncope who underwent a head-up Tilt Test. All subjects were genotyped for the 3A/4A polymorphism of the EDN1 gene and the H323H T/C polymorphism of the EDNRA gene. Results Fifty-eight patients (54%) fainted. In terms of the EDNRA polymorphism, eight subjects (8%) had the T/T genotype, 41 were heterozygous (38%) and 58 homozygous (54%) for the C allele. Sixty subjects (56%) carried homozygosis for the 3A allele of the EDN1 polymorphism and 47 were heterozygous (44%). The 4A allele was significantly more frequent in the patients who responded positively to the Tilt Test than in those who did not: the relative odds ratios and confidence intervals at univariate and multivariate analyses were respectively 2.37 (1.07−5.26) and 2.41 (1.05−5.49). Comparisons with a control group further supported these data. Among the Tilt-positive patients, the carriers of the 4A allele were more likely to have a vasodepressive pattern than those who were homozygous for the 3A variant. Interpretation The 3A/4A polymorphism of the EDN1 gene affects susceptibility to syncope, and the 4A variant associated with increased endothelin-1 expression may promote vasodepressive hemodynamic responses during Tilt Testing.
David Lee Guyton - One of the best experts on this subject based on the ideXlab platform.
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the sensitivity of the bielschowsky head Tilt Test in diagnosing acquired bilateral superior oblique paresis
American Journal of Ophthalmology, 2014Co-Authors: Brinda Muthusamy, Kristina Irsch, Han Ying Peggy Chang, David Lee GuytonAbstract:� PURPOSE: To determine the sensitivity of the Bielschowsky head-Tilt Test and other commonly used criteria in identifying patients with true bilateral superior oblique paresis. � DESIGN: A retrospective chart reviewwas performed to identify patients seen between 1978 and 2009 who were diagnosedwithacquired bilateralsuperiorobliqueparesis. � METHODS: All patients had a confirmed history of head trauma or brain surgery with altered consciousness followed by symptomatic diplopia. Bilateral superior oblique paresis was defined and diagnosed by the above history, including the presence of greater extorsion in downgaze than upgaze on Lancaster red-green Testing, a V-pattern strabismus, and bilateral fundus extorsion. We analyzed findings of the Bielschowsky head-Tilt Test, the Parks 3-step Test, and reversal of the hypertropia from straight-ahead gaze to the other 8 diagnostic positions of gaze to determine these Tests’ sensitivity in identifying true bilateral superior oblique paresis. � RESULTS: Twenty-fivepatientswereidentifiedwiththe diagnosis of true bilateral superior oblique paresis. The Bielschowsky head-Tilt Test had a 40% sensitivity, the Parks 3-step Test had a sensitivity of 24%, and reversal of the hypertropia had a sensitivity of 60% in making the diagnosis of true bilateral superior oblique paresis. � CONCLUSIONS: What previously has been described as masked bilateral superior oblique paresis simply may be a reflection of inherent poor sensitivity of the Bielschowsky head-Tilt Test, the Parks 3-step Test, and reversal of the hypertropia in diagnosing bilateral superior oblique paresis. Hence, none of these Tests should be relied on exclusively to make this diagnosis. (Am J Ophthalmol 2014;157:901‐907. 2014 by Elsevier Inc. All rights reserved.)
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the sensitivity of the bielschowsky head Tilt Test in diagnosing acquired bilateral superior oblique paresis
American Journal of Ophthalmology, 2014Co-Authors: Brinda Muthusamy, Kristina Irsch, Han Ying Peggy Chang, David Lee GuytonAbstract:Purpose To determine the sensitivity of the Bielschowsky head-Tilt Test and other commonly used criteria in identifying patients with true bilateral superior oblique paresis. Design A retrospective chart review was performed to identify patients seen between 1978 and 2009 who were diagnosed with acquired bilateral superior oblique paresis. Methods All patients had a confirmed history of head trauma or brain surgery with altered consciousness followed by symptomatic diplopia. Bilateral superior oblique paresis was defined and diagnosed by the above history, including the presence of greater extorsion in downgaze than upgaze on Lancaster red-green Testing, a V-pattern strabismus, and bilateral fundus extorsion. We analyzed findings of the Bielschowsky head-Tilt Test, the Parks 3-step Test, and reversal of the hypertropia from straight-ahead gaze to the other 8 diagnostic positions of gaze to determine these Tests' sensitivity in identifying true bilateral superior oblique paresis. Results Twenty-five patients were identified with the diagnosis of true bilateral superior oblique paresis. The Bielschowsky head-Tilt Test had a 40% sensitivity, the Parks 3-step Test had a sensitivity of 24%, and reversal of the hypertropia had a sensitivity of 60% in making the diagnosis of true bilateral superior oblique paresis. Conclusions What previously has been described as masked bilateral superior oblique paresis simply may be a reflection of inherent poor sensitivity of the Bielschowsky head-Tilt Test, the Parks 3-step Test, and reversal of the hypertropia in diagnosing bilateral superior oblique paresis. Hence, none of these Tests should be relied on exclusively to make this diagnosis.
D Th Kremastinos - One of the best experts on this subject based on the ideXlab platform.
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Head-up Tilt Test with clomipramine challenge in vasovagal syndrome—a new Tilt Testing protocol
European Heart Journal, 2003Co-Authors: George N Theodorakis, Efthimios G. Livanis, Panagiota Flevari, Manolis Markianos, Dionyssios Leftheriotis, D Th KremastinosAbstract:Purpose The aim of the study was to randomly compare clomipramine, used as a challenge-agent during head-up Tilt Test, with isoproterenol, used in the conventional Test, in patients with vasovagal syndrome. Subjects and methods The serotonergic re-uptake inhibitor clomipramine was infused (5 mg in 5 min) at the start of head-up Tilt Test (Clom-HUT) in 126 patients (mean age 41±16 years) with positive history of recurrent neurocardiogenic syncope, and in 54 healthy control subjects (mean age 46±15 years). All subjects had also been Tested with a conventional 60° head-up Tilt Test (Con-HUT) for 30 min and, if negative, isoproterenol infusion was performed at the end of the Test. The two Tests were performed in a random order with a 24-h interval between them. Results Fifty-two of the 126 patients (41%) and two of the 54 controls had a positive response to Con-HUT. In the Clom-HUT the proportion of patients who experienced a positive response increased to 83% (105 subjects), while this happened only to four control subjects. The predictive accuracy of Clom-HUT increased compared to Con-HUT from 58 to 86%, respectively. Conclusion The results indicate an increased responsiveness of central serotonergic neural system in subjects with vasovagal syndrome, the activation of which leads to sympathetic withdrawal. The use of clomipramine infusion during Tilt Test seems to improve considerably its diagnostic value.
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Head-up Tilt Test with clomipramine challenge in vasovagal syndrome--a new Tilt Testing protocol.
European heart journal, 2003Co-Authors: George N Theodorakis, Efthimios G. Livanis, Panagiota Flevari, Manolis Markianos, Dionyssios Leftheriotis, D Th KremastinosAbstract:PURPOSE The aim of the study was to randomly compare clomipramine, used as a challenge-agent during head-up Tilt Test, with isoproterenol, used in the conventional Test, in patients with vasovagal syndrome. SUBJECTS AND METHODS The serotonergic re-uptake inhibitor clomipramine was infused (5mg in 5min) at the start of head-up Tilt Test (Clom-HUT) in 126 patients (mean age 41+/-16 years) with positive history of recurrent neurocardiogenic syncope, and in 54 healthy control subjects (mean age 46+/-15 years). All subjects had also been Tested with a conventional 60 degrees head-up Tilt Test (Con-HUT) for 30 min and, if negative, isoproterenol infusion was performed at the end of the Test. The two Tests were performed in a random order with a 24-h interval between them. RESULTS Fifty-two of the 126 patients (41%) and two of the 54 controls had a positive response to Con-HUT. In the Clom-HUT the proportion of patients who experienced a positive response increased to 83% (105 subjects), while this happened only to four control subjects. The predictive accuracy of Clom-HUT increased compared to Con-HUT from 58 to 86%, respectively. CONCLUSION The results indicate an increased responsiveness of central serotonergic neural system in subjects with vasovagal syndrome, the activation of which leads to sympathetic withdrawal. The use of clomipramine infusion during Tilt Test seems to improve considerably its diagnostic value.
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Provocation of Neurocardiogenic Syncope by Clomipramine Administration During the Head-Up Tilt Test in Vasovagal Syndrome
Journal of the American College of Cardiology, 2000Co-Authors: George N Theodorakis, Efthimios G. Livanis, Elias Zarvalis, Panagiota Flevari, Manolis Markianos, D Th KremastinosAbstract:OBJECTIVES We sought to Test the hypothesis that activation of the serotonergic system in patients with vasovagal syndrome during the head-up Tilt Test provokes syncope. BACKGROUND Central serotonergic activation participates in the pathogenesis of neurocardiogenic syncope. Drugs increasing serotonin (5-HT) in the central nervous system have not been Tested as drug challenges during the head-up Tilt Test with clomipramine (Clom-HUT). METHODS The serotonergic re-uptake inhibitor clomipramine was infused (5 mg in 5 min) at the start of Clom-HUT in 55 patients (mean age 40 ± 17 years) with a positive history of recurrent neurocardiogenic syncope and in 22 healthy control subjects (mean age 46 ± 15 years). Blood samples were taken at 0, 5, 10 and 20 min for estimation of plasma prolactin and cortisol as neuroendocrine indicators of central serotonergic responsitivity. All subjects had been previously Tested with a basic 60° head-up Tilt Test (B-HUT) for 30 min, and if negative, isoproterenol infusion was given at the end of the Test. RESULTS Twenty-nine (53%) of the 55 patients and none of the 22 control subjects had a positive result in the B-HUT. With Clom-HUT, the proportion of patients who experienced a positive response increased to 80% (n = 44), although this happened to only one control subject. Prolactin and cortisol plasma levels increased significantly in the positive Clom-HUT patient group only. CONCLUSIONS The results indicate an increased responsitivity of the central serotonergic neural system in subjects with vasovagal syndrome, the activation of which leads to sympathetic withdrawal. The use of clomipramine infusion with the Tilt Test seems to considerably improve its diagnostic value.
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provocation of neurocardiogenic syncope by clomipramine administration during the head up Tilt Test in vasovagal syndrome
Journal of the American College of Cardiology, 2000Co-Authors: George N Theodorakis, Efthimios G. Livanis, Elias Zarvalis, Panagiota Flevari, Manolis Markianos, D Th KremastinosAbstract:AbstractOBJECTIVESWe sought to Test the hypothesis that activation of the serotonergic system in patients with vasovagal syndrome during the head-up Tilt Test provokes syncope.BACKGROUNDCentral ser...
Brinda Muthusamy - One of the best experts on this subject based on the ideXlab platform.
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the sensitivity of the bielschowsky head Tilt Test in diagnosing acquired bilateral superior oblique paresis
American Journal of Ophthalmology, 2014Co-Authors: Brinda Muthusamy, Kristina Irsch, Han Ying Peggy Chang, David Lee GuytonAbstract:� PURPOSE: To determine the sensitivity of the Bielschowsky head-Tilt Test and other commonly used criteria in identifying patients with true bilateral superior oblique paresis. � DESIGN: A retrospective chart reviewwas performed to identify patients seen between 1978 and 2009 who were diagnosedwithacquired bilateralsuperiorobliqueparesis. � METHODS: All patients had a confirmed history of head trauma or brain surgery with altered consciousness followed by symptomatic diplopia. Bilateral superior oblique paresis was defined and diagnosed by the above history, including the presence of greater extorsion in downgaze than upgaze on Lancaster red-green Testing, a V-pattern strabismus, and bilateral fundus extorsion. We analyzed findings of the Bielschowsky head-Tilt Test, the Parks 3-step Test, and reversal of the hypertropia from straight-ahead gaze to the other 8 diagnostic positions of gaze to determine these Tests’ sensitivity in identifying true bilateral superior oblique paresis. � RESULTS: Twenty-fivepatientswereidentifiedwiththe diagnosis of true bilateral superior oblique paresis. The Bielschowsky head-Tilt Test had a 40% sensitivity, the Parks 3-step Test had a sensitivity of 24%, and reversal of the hypertropia had a sensitivity of 60% in making the diagnosis of true bilateral superior oblique paresis. � CONCLUSIONS: What previously has been described as masked bilateral superior oblique paresis simply may be a reflection of inherent poor sensitivity of the Bielschowsky head-Tilt Test, the Parks 3-step Test, and reversal of the hypertropia in diagnosing bilateral superior oblique paresis. Hence, none of these Tests should be relied on exclusively to make this diagnosis. (Am J Ophthalmol 2014;157:901‐907. 2014 by Elsevier Inc. All rights reserved.)
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the sensitivity of the bielschowsky head Tilt Test in diagnosing acquired bilateral superior oblique paresis
American Journal of Ophthalmology, 2014Co-Authors: Brinda Muthusamy, Kristina Irsch, Han Ying Peggy Chang, David Lee GuytonAbstract:Purpose To determine the sensitivity of the Bielschowsky head-Tilt Test and other commonly used criteria in identifying patients with true bilateral superior oblique paresis. Design A retrospective chart review was performed to identify patients seen between 1978 and 2009 who were diagnosed with acquired bilateral superior oblique paresis. Methods All patients had a confirmed history of head trauma or brain surgery with altered consciousness followed by symptomatic diplopia. Bilateral superior oblique paresis was defined and diagnosed by the above history, including the presence of greater extorsion in downgaze than upgaze on Lancaster red-green Testing, a V-pattern strabismus, and bilateral fundus extorsion. We analyzed findings of the Bielschowsky head-Tilt Test, the Parks 3-step Test, and reversal of the hypertropia from straight-ahead gaze to the other 8 diagnostic positions of gaze to determine these Tests' sensitivity in identifying true bilateral superior oblique paresis. Results Twenty-five patients were identified with the diagnosis of true bilateral superior oblique paresis. The Bielschowsky head-Tilt Test had a 40% sensitivity, the Parks 3-step Test had a sensitivity of 24%, and reversal of the hypertropia had a sensitivity of 60% in making the diagnosis of true bilateral superior oblique paresis. Conclusions What previously has been described as masked bilateral superior oblique paresis simply may be a reflection of inherent poor sensitivity of the Bielschowsky head-Tilt Test, the Parks 3-step Test, and reversal of the hypertropia in diagnosing bilateral superior oblique paresis. Hence, none of these Tests should be relied on exclusively to make this diagnosis.
George N Theodorakis - One of the best experts on this subject based on the ideXlab platform.
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Head-up Tilt Test with clomipramine challenge in vasovagal syndrome—a new Tilt Testing protocol
European Heart Journal, 2003Co-Authors: George N Theodorakis, Efthimios G. Livanis, Panagiota Flevari, Manolis Markianos, Dionyssios Leftheriotis, D Th KremastinosAbstract:Purpose The aim of the study was to randomly compare clomipramine, used as a challenge-agent during head-up Tilt Test, with isoproterenol, used in the conventional Test, in patients with vasovagal syndrome. Subjects and methods The serotonergic re-uptake inhibitor clomipramine was infused (5 mg in 5 min) at the start of head-up Tilt Test (Clom-HUT) in 126 patients (mean age 41±16 years) with positive history of recurrent neurocardiogenic syncope, and in 54 healthy control subjects (mean age 46±15 years). All subjects had also been Tested with a conventional 60° head-up Tilt Test (Con-HUT) for 30 min and, if negative, isoproterenol infusion was performed at the end of the Test. The two Tests were performed in a random order with a 24-h interval between them. Results Fifty-two of the 126 patients (41%) and two of the 54 controls had a positive response to Con-HUT. In the Clom-HUT the proportion of patients who experienced a positive response increased to 83% (105 subjects), while this happened only to four control subjects. The predictive accuracy of Clom-HUT increased compared to Con-HUT from 58 to 86%, respectively. Conclusion The results indicate an increased responsiveness of central serotonergic neural system in subjects with vasovagal syndrome, the activation of which leads to sympathetic withdrawal. The use of clomipramine infusion during Tilt Test seems to improve considerably its diagnostic value.
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Head-up Tilt Test with clomipramine challenge in vasovagal syndrome--a new Tilt Testing protocol.
European heart journal, 2003Co-Authors: George N Theodorakis, Efthimios G. Livanis, Panagiota Flevari, Manolis Markianos, Dionyssios Leftheriotis, D Th KremastinosAbstract:PURPOSE The aim of the study was to randomly compare clomipramine, used as a challenge-agent during head-up Tilt Test, with isoproterenol, used in the conventional Test, in patients with vasovagal syndrome. SUBJECTS AND METHODS The serotonergic re-uptake inhibitor clomipramine was infused (5mg in 5min) at the start of head-up Tilt Test (Clom-HUT) in 126 patients (mean age 41+/-16 years) with positive history of recurrent neurocardiogenic syncope, and in 54 healthy control subjects (mean age 46+/-15 years). All subjects had also been Tested with a conventional 60 degrees head-up Tilt Test (Con-HUT) for 30 min and, if negative, isoproterenol infusion was performed at the end of the Test. The two Tests were performed in a random order with a 24-h interval between them. RESULTS Fifty-two of the 126 patients (41%) and two of the 54 controls had a positive response to Con-HUT. In the Clom-HUT the proportion of patients who experienced a positive response increased to 83% (105 subjects), while this happened only to four control subjects. The predictive accuracy of Clom-HUT increased compared to Con-HUT from 58 to 86%, respectively. CONCLUSION The results indicate an increased responsiveness of central serotonergic neural system in subjects with vasovagal syndrome, the activation of which leads to sympathetic withdrawal. The use of clomipramine infusion during Tilt Test seems to improve considerably its diagnostic value.
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Provocation of Neurocardiogenic Syncope by Clomipramine Administration During the Head-Up Tilt Test in Vasovagal Syndrome
Journal of the American College of Cardiology, 2000Co-Authors: George N Theodorakis, Efthimios G. Livanis, Elias Zarvalis, Panagiota Flevari, Manolis Markianos, D Th KremastinosAbstract:OBJECTIVES We sought to Test the hypothesis that activation of the serotonergic system in patients with vasovagal syndrome during the head-up Tilt Test provokes syncope. BACKGROUND Central serotonergic activation participates in the pathogenesis of neurocardiogenic syncope. Drugs increasing serotonin (5-HT) in the central nervous system have not been Tested as drug challenges during the head-up Tilt Test with clomipramine (Clom-HUT). METHODS The serotonergic re-uptake inhibitor clomipramine was infused (5 mg in 5 min) at the start of Clom-HUT in 55 patients (mean age 40 ± 17 years) with a positive history of recurrent neurocardiogenic syncope and in 22 healthy control subjects (mean age 46 ± 15 years). Blood samples were taken at 0, 5, 10 and 20 min for estimation of plasma prolactin and cortisol as neuroendocrine indicators of central serotonergic responsitivity. All subjects had been previously Tested with a basic 60° head-up Tilt Test (B-HUT) for 30 min, and if negative, isoproterenol infusion was given at the end of the Test. RESULTS Twenty-nine (53%) of the 55 patients and none of the 22 control subjects had a positive result in the B-HUT. With Clom-HUT, the proportion of patients who experienced a positive response increased to 80% (n = 44), although this happened to only one control subject. Prolactin and cortisol plasma levels increased significantly in the positive Clom-HUT patient group only. CONCLUSIONS The results indicate an increased responsitivity of the central serotonergic neural system in subjects with vasovagal syndrome, the activation of which leads to sympathetic withdrawal. The use of clomipramine infusion with the Tilt Test seems to considerably improve its diagnostic value.
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provocation of neurocardiogenic syncope by clomipramine administration during the head up Tilt Test in vasovagal syndrome
Journal of the American College of Cardiology, 2000Co-Authors: George N Theodorakis, Efthimios G. Livanis, Elias Zarvalis, Panagiota Flevari, Manolis Markianos, D Th KremastinosAbstract:AbstractOBJECTIVESWe sought to Test the hypothesis that activation of the serotonergic system in patients with vasovagal syndrome during the head-up Tilt Test provokes syncope.BACKGROUNDCentral ser...
