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Comparative Study
. 2025 Nov 11;25(1):800.
doi: 10.1186/s12872-025-05290-7.

Sex-Specific heart rate acceleration as predictors of positive head-up tilt test outcomes in syncope patients

Carlos Eduardo Batista de Lima  1 , Patryck Araújo Dantas da Silva  2 , Sheila Raquel Alves de Sá Nascimento  2 , Marina Vilarinho Alves de Freitas  3 , Frankeline Gonçalves de Arêa Leão Moreira  4 , Valmir Oliveira Silvino  5 , Ricardo Martins Ramos  6 , Marcos Antonio Pereira Dos Santos  7   8
Affiliations
Comparative Study

Sex-Specific heart rate acceleration as predictors of positive head-up tilt test outcomes in syncope patients

Carlos Eduardo Batista de Lima et al. BMC Cardiovasc Disord. .

Abstract

Background: Head-up tilt test (HUTT) is widely used to evaluate patients with unexplained syncope, but data on clinical predictors of HUTT results are limited. This study aimed to evaluate heart rate (HR) acceleration and blood pressure (BP) changes associated with the HUTT results in syncope patients and the differences according to sex.

Methods: A cross-sectional study was performed with patients who presented with unexplained syncope and were subjected to HUTT (70-degree angle) from January 2011 to April 2015. BP changes and Receiver Operating Characteristic (ROC) curves for the maximum interval in HR acceleration from the first to the tenth minute (delta-HR 10) after tilting were analyzed. The significance level was set at 5%.

Results: Of 149 patients (mean age: 28.5 ± 29 years), 40 (26.85%) had a positive HUTT. The delta-HR 10 acceleration was higher in the positive group (14.0 ± 9.25 bpm vs. 9.0 ± 11 bpm, p = 0.002). When considering sex, a cut-off point of 12 bpm was found, with an area under the curve of 0.805 for females, showing a sensitivity of 80% and a negative predictive value of 91.2%, and an area under the curve of 0.580 for males, with a sensitivity of 52% and a negative predictive value of 73.9%.

Conclusions: The HR acceleration of 12 bpm up to the tenth minute after tilting was an independent predictor of a positive HUTT in female syncope patients, demonstrating good sensitivity, accuracy, and negative predictive value.

Trial registration: ClinicalTrials.gov Identifier: NCT06496074.

Keywords: Blood pressure; HUTT; Heart rate acceleration; Hemodynamics; Vasovagal syncope.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the ethics and research committee of the Federal University of Piauí under number 1.132.024. Consent for publication: The need for informed consent had been waived by the Ethics Committee of the Federal University of Piauí due to the retrospective nature of the study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flowchart. Abbreviation: HUTT, Head-up tilt test
Fig. 2
Fig. 2
ROC Curve: Delta-HR 10; cut-off point 12 bpm according to the sex (female n = 59 and male n = 90). Delta-HR 10 = maximum heart rate acceleration from the first minute up to the tenth minute of the tilt phase. ROC = Receiver Operating Characteristic
See this image and copyright information in PMC

References

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