ABSTRACT
AIMS: Drinking alcohol is known to be one of the triggering factors of neurally-mediated syncope. Little is known about the diagnostic utility of the conventional and alcohol provocation head up tilt-test (HUT) in patients with alcohol-related syncope. We investigated the effect of the alcohol provocation HUT. METHODS AND RESULTS: We studied 12 patients (8 males, age 51 +/- 19 years) who had a history of unexplained post-alcohol ingestion syncope. An alcohol provocation protocol HUT (alcohol HUT), in which the protocol required 350 mL of 5% alcohol beer to be drunk over 5 min followed by positioning with the table tilted up for up to 30 min, was performed after the control and isoproterenol (ISP) HUT. None of the subjects (0/12) exhibited a positive response in the control HUT, and only one subject had a positive response (1/12; 8.3%) in the ISP HUT. In the alcohol HUT a positive response (9/12; 75%) increased in the patient group, whereas there were no positive responses in the normal control group. CONCLUSION: In the conventional HUT protocols, including ISP provocation, it was difficult to produce a positive response in the patients with alcohol-related syncope. Alcohol ingestion was a useful diagnostic provocation method in such patients.
Subject(s)
Alcohol Drinking/adverse effects , Ethanol , Syncope/chemically induced , Syncope/diagnosis , Tilt-Table Test/methods , Female , Humans , Male , Middle Aged , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
BACKGROUND: Total cosine R-to-T (TCRT) is a descriptor of T-wave morphology analysis based on singular value decomposition of 12-lead electrocardiograms (ECGs), which is useful in risk stratification of patients with myocardial infarction (MI). A new marker of standard ECG substituted for TCRT is proposed and the aim of this study was to evaluate the correlation between the new index and TCRT in patients with cardiomyopathy and MI. METHODS AND RESULTS: Patients were divided into 2 groups: patients with cardiomyopathy (group CM, n=21, male =13), and patients with MI (group MI, n=36, male =28). TCRT was calculated using a custom software package. The ventricular gradient (VG)-index was defined as the total number of leads with opposite vectors for the QRS and T-wave. The value of TCRT was significantly lower in group CM than in group MI (-0.50+/-0.51 vs -0.04+/-0.65, p<0.01). The value for the VG-index was significantly greater in group CM than in group MI (5.9+/-3.4 vs 4.2+/-2.4, p<0.05). There was a significant correlation between TCRT and the VG-index in all of the patients (r(2)=0.47). CONCLUSION: The VG-index is significantly correlated with TCRT, and both descriptors distinguish patients with MI from those with cardiomyopathy.
