TILT TEST-RESULTS IN YOUNG AND ELDERLY PATIENTS WITH SYNCOPE OF UNKNOWN ORIGIN

The effects of aging on the results of prolonged drug-free tilt testin g were studied in 175 consecutive patients with unexplained syncope di vided into 3 groups: 59 patients <40 years old; 57 patients between 40 and 60 years, and 59 patients >60 years old. Tilt-induced vaso-vagal syncope occurred respectively in 17 (29%), 20 (35%), and 18 patients ( 31%) in the 3 age groups. Vasodepressor, mixed, and cardioinhibitory v aso-vagal syncope occurred similarly in the 3 groups: organic heart di sease and systemic hypertension were more frequent in elderly patients without affecting the incidence of tilt-induced syncope. Blood pressu re and heart rate variations during syncope were similar in the 3 age groups, in the first 20 minutes of tilt testing, before the appearance of the vaso-vagal reflex, elderly patients showed greater reduction i n blood pressure and smaller increase in heart rate than younger patie nts. Our data indicate that increasing age determines a different bloo d pressure and heart rate behavior during tilt testing, but apparently does not influence the incidence of vaso-vagal syncope in patients wi th syncope of undetermined etiology. As the proportion of patients wit h a positive isoproterenol tilt test was reported to decline with age, our results suggest that the reduced incidence of syncope during isop roterenol tilt testing could be the expression of impaired autonomic r esponse among elderly syncope patients. (C) 1996, Editrice Kurtis