Racial Differences in Response to Tilt-Table Testing in Patients Refered.

Abstract

Background: Syncope is a common problem in the general population and results in significant societal and patient costs. Several small studies have demonstrated differences in orthostatic response, and possibly tolerance, between blacks and whites. Based on these observations, we retrospectively reviewed results from our tilt table database to identify potential differences in response to tilt-table testing with regards to race, between black and white patients.

Methods: The reports of 446 tilt-table tests performed on adults, older than 18 years of age, at Boston Medical Center, an urban, tertiary-care, academic hospital, were reviewed. Clinical variables were retrieved from the procedure report. Occurrence of syncope was noted and hemodynamic classification was recorded as neurocardiogenic response, with subcategories of mixed, vasodepressor, or cardio-inhibitory.

Results: Of records reviewed, 360 patients (80.7%) identified as white and 86 patients as black (19.3%). There was a significantly lower observed frequency of syncope with a neurocardiogenic response in black vs. white patients (45.5% vs. 60.3%, p=0.015). In addition, significantly fewer black patients demonstrated a mixed neuro-cardiogenic response as compared to white patients (7.0% vs. 15.8%, p=0.038) or cardio-inhibitory response (0% vs. 5.3%, p=0.032). There was no difference in frequency of vasodepressor response in black vs. white patients (39.2 vs.38.4%, p=1.000).

Conclusions: We observed a statistically-significant lower incidence of neurocardiogenic syncope among black patients compared to white patients referred for tilt-table testing for evaluation of syncope.