{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T09:42:16Z","timestamp":1762508536838,"version":"3.40.5"},"reference-count":34,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T00:00:00Z","timestamp":1624492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["843002707"],"award-info":[{"award-number":["843002707"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To define and evaluate hemodynamic criteria to distinguish between classical orthostatic hypotension (cOH) and vasovagal syncope (VVS) in tilt table testing (TTT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Inclusion criteria for VVS were a history of VVS and tilt\u2010induced syncope defined as a blood pressure (BP) decrease and electroencephalographic changes during syncope with complaint recognition. Criteria for cOH were a history of cOH and a BP decrease meeting published criteria. Clinical diagnoses were established prior to TTT. We assessed (1)\u00a0whether the decrease of systolic BP accelerated, \u201cconvex,\u201d or decelerated, \u201cconcave\u201d; (2) the time from head\u2010up tilt to when BP reached one\u2010half its maximal decrease; (3) the difference between baseline heart rate (HR) and HR at BP nadir. We calculated the diagnostic yield of optimized thresholds of these features and their combinations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 82 VVS cases (40% men, median age 44\u00a0years) and 65 cOH cases (66% men, median age 70\u00a0years). BP decrease was concave in cOH in 79% and convex in VVS in 94% (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). The time to reach half the BP decrease was shorter in cOH (median 34\u00a0sec, interquartile range (IQR) 19\u201398\u00a0sec) than in VVS (median 1571\u00a0sec, IQR 1381\u20131775\u00a0sec, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). Mean HR increased by 11\u00a0\u00b1\u00a011\u00a0bpm in cOH and decreased by 20\u00a0\u00b1\u00a019\u00a0bpm in VVS (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). When all three features pointed to VVS, sensitivity for VVS was 82% and specificity was 100%. When all three pointed to cOH, sensitivity for cOH was 71% and specificity was 100%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>These new hemodynamic criteria reliably differentiate cOH from VVS.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.51412","type":"journal-article","created":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T19:29:00Z","timestamp":1624562940000},"page":"1635-1645","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["New hemodynamic criteria to separate classical orthostatic hypotension from vasovagal syncope"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5160-2800","authenticated-orcid":false,"given":"Maryam","family":"Ghariq","sequence":"first","affiliation":[{"name":"Department of Neurology Leiden University Medical Centre Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8588-3273","authenticated-orcid":false,"given":"Fabian I.","family":"Kerkhof","sequence":"additional","affiliation":[{"name":"Department of Neurology Leiden University Medical Centre Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7784-1807","authenticated-orcid":false,"given":"Robert H.","family":"Reijntjes","sequence":"additional","affiliation":[{"name":"Department of Neurology Leiden University Medical Centre Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1435-8970","authenticated-orcid":false,"given":"Roland D.","family":"Thijs","sequence":"additional","affiliation":[{"name":"Department of Neurology Leiden University Medical Centre Leiden The Netherlands"},{"name":"Stichting Epilepsie Instellingen Nederland (SEIN) Heemstede The Netherlands"},{"name":"NIHR University College London Hospitals Biomedical Research Centre London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6953-7573","authenticated-orcid":false,"given":"J. 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