ArticleBMC cardiovascular disorders2026
Diagnostic value of short-duration head-up tilt test for unexplained syncope: a non-inferiority study.
Article in BMC cardiovascular disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe traditional head-up tilt test (HUTT) is time-consuming, imposing a noticeable burden on patients and on high-throughput syncope clinics. A 20-minute "Fast Italian Protocol," introduced in 2023, promises to streamline the procedure, yet its diagnostic reliability-particularly the optimal length of the sublingual nitroglycerin head-up tilt test (SNHUT) segment-remains unclear.
methodsBetween 2019 and 2025 we assessed 1,218 consecutive patients with unexplained syncope. Individuals were allocated non-randomly to a short protocol (10-minute baseline head-up tilt test (BHUT) + 20-minute SNHUT; n = 393) or the conventional protocol (20-minute BHUT + 20-minute SNHUT; n = 825). A one-sided non-inferiority analysis (α = 0.025; margin = - 10%) provided 90.7% statistical power.
resultsOverall positivity did not differ between the short and conventional protocols (53.4% vs. 57.3%, p = 0.20), nor did the distribution of vasovagal reaction types (all p > 0.05). In the abbreviated arm, 86.4% of positive responses emerged within the first 10 min of tilt or nitroglycerin exposure, and 98.9% appeared within 15 min-proportions virtually identical to those observed with the conventional protocol (88.9% and 98.9%, respectively; p = 0.49).
conclusionA 10-minute BHUT followed by a 20-minute SNHUT is diagnostically non-inferior to the standard 40-minute test. Furthermore, curtailing the SNHUT phase to 15 min retains 98.9% of positive findings while trimming total test time by 37.5%. This streamlined approach could ease patient burden and significantly boost throughput in high-volume syncope centers.
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