Does Head-Up Tilt Test Response Predict Major Adverse Cardiovascular Events In Syncope Patients: A Single-Center Long Term Observation of 2088 patients.

INTRODUCTION: Head-up tilt table test is useful for the evaluation of vasovagal or orthostatic syncope patients. In this study, we aimed to investigate long-term major adverse cardiovascular events in vasovagal syncope patients who showed a positive response to the head up tilt table test.
METHODS: In this single-center descriptive study, all patients admitted to the cardiology tilt test laboratory in a university hospital between 1996-2020 were included. Mortality data of all patients were questioned in 2024. A chi-square test to compare categorical variables, and Mann-Whitney U and Kruskal Wallis tests to compare numerical variables without normal distribution were used. A p-value of <0.05 was accepted for statistical significance.
RESULTS: 1016 of a total of 2088 patients had a positive response to the tilt table. The frequencies of outcomes were respectively vasodepressor type (46.6%), type-1 mix type (37.8%), cardio-inhibitor type-2 (10.8%) and cardio-inhibitor type-1 (4.8%). The median age of the patients with cardio-inhibitor type-2 was significantly lower compared to type-1 mix and vasodepressor types (p=0.001). Patients with cardio-inhibitory type-1 response had a relatively higher all cause mortality and mace rates than the tilt negative group and other tilt positive groups.
DISCUSSION AND CONCLUSION: Vasovagal syncope is generally not associated with mortality, but it should be kept in mind that long-term adverse cardiovascular events may occur in patients with cardioinhibitory type 1 features detected by tilt table test.

Keywords: Head-up tilt-table test, Vasovagal syncope, Vasodepressor syncope, Cardiogenic syncope