Pakistan Armed Forces Medical Journal (Jul 2023)
COMPARISON OF DIFFERENT TYPES OF RESPONSES TO TILT-TABLE TESTING IN PATIENTS OF BOTH GENDERS WITH UNEXPLAINED SYNCOPE
Abstract
Objective: To compare the frequency of various types of responses in both genders undergoing tilt table test with unexplained syncope. Study Design: A comparative cross-sectional study. Place and Duration of Study: Department of EP studies, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from Aug 2017 to Jan 2018. Material and Methods: Patients were recruited through non-probability consecutive sampling. Patients of all age groups of both genders who had syncope as per operational definition were included in our study. Patients who were excluded from the study were, newly diagnosed or previously established history of arrhythmias, coronary artery disease, cardiomyopathies and structural heart disease e.g. HOCM, aortic stenosis, mitral stenosis. Patients who had history of epilepsy on medical record and history of anemia on medical record were also excluded from the study. Base line demographic information of patients (age, gender, duration of complain) and types of responses were recorded on especially designed proforma. Results: Total 294 patients were recruited for the study. Mean age of the patients was 46.7 ± 8.1 years, with minimum age 12 years and maximum age 85 years. Male patients were found to be 244 (82.4%) while female patients were 50 (16.9%). Mean duration of complaints was 1.5 ± 1.7 months. Our study showed that the most common type of response in male and females were mixed type (88.1%) and (84%) respectively, with the p-value of 0.022. while, cardioinhibitory type response was (2.8%) but found in male gender only. Next most common type was vasodepressor type response common in females than males with 6% and 2.4% respectively. Subsequently, less frequent type of response was showed with classic type of orthrostatic hypotension (2%) while type Initial orthrostatic hypotension was not recoreded in the study. Females were more frequent than males in Progressive orthrostatic hypotension with (5%) and (0.4%) in males. POTS response was not present in either gender. Conclusion: As our study showed, among type of responses, mixed type of response has a significantly high positive rate being more common in male gender, while vasodepressive type and progressive orthostatic hypotension type being more common in female gender. Tilt-table testing plays a major role during the evaluation of syncope patients, helps to differentiate syncope subtypes and could be useful in guiding treatment. however, the need for using another protocol with a similar diagnostic accuracy in gender specificity is necessary.
