{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T17:37:26Z","timestamp":1792431446283,"version":"4.5.0"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"27","license":[{"start":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T00:00:00Z","timestamp":1685664000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The traditional nitroglycerin (NTG) head-up tilt test (HUTT) is time-consuming and the test duration is a barrier to widespread utilization in clinical practice. It was hypothesized that a short-duration protocol is not inferior to the traditional protocol regarding the positivity rate and has a similar distribution of hemodynamic response.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Patients undergoing HUTT were randomized 1:1 to a 10 min passive phase plus a 10 min 0.3 mg NTG if the passive phase was negative (Fast) or to a 20 min passive phase plus a 15 min 0.3 mg NTG if the passive phase was negative (Traditional). A sample size of 277 patients for each group achieved 80% power to detect an expected difference of 0% with a non-inferiority margin of -10% using a one-sided t-test and assuming a significant level alpha of 0.025. A total of 554 consecutive patients (mean age 46.6 \u00b1 19.3 years, 47.6% males) undergoing HUTT for suspected vasovagal syncope were randomly assigned to the Fast (n = 277) or Traditional (n = 277) protocol. A positive response was defined as the induction of syncope in presence of hypotension\/bradycardia, and was observed in 167 (60.3%) patients with Fast and in 162 (58.5%) patients with the Traditional protocol. There was a trend of lesser vasodepressor response (14.8% Fast vs. 20.6% Traditional) which was significant during the passive phase (P = 0.01).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The diagnostic value of the Fast HUTT protocol is similar to that of the Traditional protocol and therefore the Fast protocol can be used instead of the Traditional protocol.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehad322","type":"journal-article","created":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T20:37:19Z","timestamp":1685738239000},"page":"2473-2479","source":"Crossref","is-referenced-by-count":41,"title":["Short-duration head-up tilt test potentiated with sublingual nitroglycerin in suspected vasovagal syncope: the fast Italian protocol"],"prefix":"10.1093","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9227-0360","authenticated-orcid":false,"given":"Vincenzo","family":"Russo","sequence":"first","affiliation":[{"name":"Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania \u2018Luigi Vanvitelli\u2019\u2014Monaldi Hospital , Piazzale E. Ruggeri, 80126 Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Parente","sequence":"additional","affiliation":[{"name":"Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania \u2018Luigi Vanvitelli\u2019\u2014Monaldi Hospital , Piazzale E. Ruggeri, 80126 Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Tomaino","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Ospedale Generale Regionale , Via Lorenz B\u00f6hler 5, 39100 Bolzano , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Comune","sequence":"additional","affiliation":[{"name":"Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania \u2018Luigi Vanvitelli\u2019\u2014Monaldi Hospital , Piazzale E. Ruggeri, 80126 Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Sabatini","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Ospedale Generale Regionale , Via Lorenz B\u00f6hler 5, 39100 Bolzano , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nunzia","family":"Laezza","sequence":"additional","affiliation":[{"name":"Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania \u2018Luigi Vanvitelli\u2019\u2014Monaldi Hospital , Piazzale E. Ruggeri, 80126 Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Carretta","sequence":"additional","affiliation":[{"name":"AOU Policlinico Consorziale di Bari-Ospedale Giovanni XXIII, Coronary Unit and Electrophysiology\/Pacing Unit, Cardio-Thoracic Department, Policlinico University Hospital of Bari , Piazza Giulio Cesare 11, 70124 Bari , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1776-8449","authenticated-orcid":false,"given":"Gerardo","family":"Nigro","sequence":"additional","affiliation":[{"name":"Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania \u2018Luigi Vanvitelli\u2019\u2014Monaldi Hospital , Piazzale E. Ruggeri, 80126 Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Rago","sequence":"additional","affiliation":[{"name":"Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania \u2018Luigi Vanvitelli\u2019\u2014Monaldi Hospital , Piazzale E. Ruggeri, 80126 Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3590-6983","authenticated-orcid":false,"given":"Paolo","family":"Golino","sequence":"additional","affiliation":[{"name":"Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania \u2018Luigi Vanvitelli\u2019\u2014Monaldi Hospital , Piazzale E. Ruggeri, 80126 Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1845-5607","authenticated-orcid":false,"given":"Michele","family":"Brignole","sequence":"additional","affiliation":[{"name":"IRCCS Istituto Auxologico Italiano, Faint and Fall Research Centre, Cardiology Unit and Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital , Piazzale Brescia 20, 20149 Milano , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,6,2]]},"reference":[{"key":"2023071400043488400_ehad322-B1","doi-asserted-by":"crossref","first-page":"1654","DOI":"10.1093\/eurheartj\/ehab084","article-title":"Tilt testing remains a valuable asset","volume":"42","author":"Sutton","year":"2021","journal-title":"Eur Heart J"},{"key":"2023071400043488400_ehad322-B2","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.ijcard.2012.09.023","article-title":"Head-up tilt testing for diagnosing vasovagal syncope: a meta-analysis","volume":"168","author":"Forleo","year":"2013","journal-title":"Int J Cardiol"},{"key":"2023071400043488400_ehad322-B3","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1053\/eupc.2000.0125","article-title":"\u2018The Italian protocol\u2019: a simplified head-up tilt testing potentiated with oral nitroglycerin to assess patients with unexplained syncope","volume":"2","author":"Bartoletti","year":"2000","journal-title":"Europace"},{"key":"2023071400043488400_ehad322-B4","doi-asserted-by":"crossref","first-page":"e43","DOI":"10.1093\/eurheartj\/ehy071","article-title":"Practical instructions for the 2018 ESC guidelines for the diagnosis and management of syncope","volume":"39","author":"Brignole","year":"2018","journal-title":"Eur Heart J"},{"key":"2023071400043488400_ehad322-B5","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1053\/eupc.1999.0064","article-title":"New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification. Analysis of the pre-syncopal phase of the tilt test without and with nitroglycerin challenge. Vasovagal syncope international study","volume":"2","author":"Brignole","year":"2000","journal-title":"Europace"},{"key":"2023071400043488400_ehad322-B6","doi-asserted-by":"crossref","first-page":"e126","DOI":"10.1161\/CIRCRESAHA.120.316662","article-title":"Novel methods for quantification of vasodepression and cardioinhibition during tilt-induced vasovagal syncope","volume":"127","author":"van Dijk","year":"2020","journal-title":"Circ Res"},{"key":"2023071400043488400_ehad322-B7","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1053\/eupc.1999.0036","article-title":"Head-up tilt testing potentiated with oral nitroglycerin: a randomized trial of the contribution of a drug-free phase and a nitroglycerin phase in the diagnosis of neurally mediated syncope","volume":"1","author":"Bartoletti","year":"1999","journal-title":"Europace"},{"key":"2023071400043488400_ehad322-B8","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1097\/HJH.0000000000002800","article-title":"Low-blood pressure phenotype underpins the tendency to reflex syncope","volume":"39","author":"Brignole","year":"2021","journal-title":"J Hypertens"},{"key":"2023071400043488400_ehad322-B9","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000019510","article-title":"What is the optimal duration of the TILT after administration of 0.4","volume":"99","author":"Glockler","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"2023071400043488400_ehad322-B10","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1016\/S0140-6736(86)91665-X","article-title":"Head-up tilt: a useful test for investigating unexplained syncope","volume":"1","author":"Kenny","year":"1986","journal-title":"Lancet"},{"key":"2023071400043488400_ehad322-B11","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/S0002-9149(99)80079-4","article-title":"Value of head-up tilt testing potentiated with sublingual nitroglycerin to assess the origin of unexplained syncope","volume":"76","author":"Raviele","year":"1995","journal-title":"Am J Cardiol"}],"container-title":["European Heart Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurheartj\/article-pdf\/44\/27\/2473\/50875251\/ehad322.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurheartj\/article-pdf\/44\/27\/2473\/50875251\/ehad322.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T00:05:08Z","timestamp":1689293108000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurheartj\/article\/44\/27\/2473\/7188709"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,2]]},"references-count":11,"journal-issue":{"issue":"27","published-online":{"date-parts":[[2023,6,2]]},"published-print":{"date-parts":[[2023,7,14]]}},"URL":"https:\/\/doi.org\/10.1093\/eurheartj\/ehad322","relation":{},"ISSN":["0195-668X","1522-9645"],"issn-type":[{"value":"0195-668X","type":"print"},{"value":"1522-9645","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,7,14]]},"published":{"date-parts":[[2023,6,2]]}}}