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Background <p>The 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.</p> Methods <p>Between 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; <i>n</i> = 393) or the conventional protocol (20-minute BHUT + 20-minute SNHUT; <i>n</i> = 825). A one-sided non-inferiority analysis (α = 0.025; margin = − 10%) provided 90.7% statistical power.</p> Results <p>Overall positivity did not differ between the short and conventional protocols (53.4% vs. 57.3%, <i>p</i> = 0.20), nor did the distribution of vasovagal reaction types (all <i>p</i> &gt; 0.05). In the abbreviated arm, 86.4% of positive responses emerged within the first 10&#xa0;min of tilt or nitroglycerin exposure, and 98.9% appeared within 15&#xa0;min—proportions virtually identical to those observed with the conventional protocol (88.9% and 98.9%, respectively; <i>p</i> = 0.49).</p> Conclusion <p>A 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&#xa0;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.</p> Graphical Abstract <p></p>

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Diagnostic value of short-duration head-up tilt test for unexplained syncope: a non-inferiority study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月7日

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  • Saijia Yang,
  • Yuen Liang,
  • Zhuoshan Huang,
  • Lin Wu,
  • Ruimin Dong,
  • Kemei Liu,
  • Shan Cao,
  • Ling Jiang,
  • Xujing Xie

摘要

Background

The 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.

Methods

Between 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.

Results

Overall 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).

Conclusion

A 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.

Graphical Abstract