Upright tilt test can be used for the diagnosis and differential diagnosis of a variety of diseases! Chinese expert consensus

The upright tilt test is an effective way
to check autonomic function.
Recently, the "Chinese Expert Consensus on the Application of Orthostatic Tilt Test Specification 2022" was released, suggesting that the orthostatic tilt test specification can be used for the diagnosis and differential diagnosis
of vasovagal syncope, orthostatic hypotension, orthostatic orthostatic tachycardia syndrome, orthostatic hypertension, psychogenic pseudosyncope, autonomic failure, unexplained repeated falls, epilepsy and other diseases.

Indications

Contraindications

The orthostatic tilt test evaluates the testing protocol for syncope

Consensus emphasises

Individualized examination protocol based on the initial assessment of syncope is of great significance
to improve the value of upright tilt test in the diagnosis of syncope and reduce the risk of examination.

Active standing tests, carotid sinus massage, heart rate variability, Valsalva test, video EEG, transcranial Doppler ultrasound, end-tidal carbon dioxide partial pressure measurement, and neuroendocrine metabolism can improve the differential diagnostic value
of the orthostatic tilt test for syncope.

Suitable for all ages

The positive diagnostic rate of orthostatic tilt test for syncope in the elderly is 90%~100%, and the safety is good
.

The upright tilt test can provide objective evidence for the etiological diagnosis of vasovagal syncope in children, and has good safety and practicality for children, and can be performed after signing the informed consent form
.

Plays a unique role in the rehabilitation of syncope patients

Studies in recent years have shown that the upright tilt test plays a unique role
in the exercise rehabilitation of neurological injuries such as cerebrovascular disease and brain injury.

Treadmilling and pedaling inclined beds are effective in treating spinal cord injuries
in athletes.
Head-low tilting beds can be used to detect vagus nerve function, baroflex sensitivity, anaphylactic shock treatment, prevention of long-term bed restlessness osteoporosis, and treatment of muscle wasting
.

Can be used to screen pacemaker-mounted patients

The 2017 US syncope guidelines do not recommend screening pacemaker therapy
by an upright tilt trial.

The 2018 European guidelines recommend that the orthostatic tilt test cardiosuppressive form be a class IIB.
indication for pacemaker therapy
.

Screening protocol: patients
aged 40 years and older, with more than 2 recent episodes of severe unexplained syncope, and patients confirmed by orthostatic tilt test as vasovagal syncope and induced cardiac arrest >3 s.

The upright tilt test confirms the temporal correlation between cardiac arrest and loss of consciousness and predicts the effectiveness of
pacemaker therapy.
Hypotension susceptibility, i.
e.
, orthostatic hypotension coexists with vasovagal syncope and cardiosuppressive type, has limited benefit from pacemaker therapy
.

Consensus states

In-depth research on the upright tilt test in the following areas is
ongoing.