Validation of the diagnostic efficacy of the fast italian protocol for tilt table testing in a german cohort: a retrospective study

Abstract Background The head-up tilt table test (HUTT) is crucial for diagnosing vasovagal syncope and orthostatic hypotension, but its lengthy protocol limits use. The Fast Italian Protocol, introduced by Russo (2023), shortens tilt duration to improve efficiency. While effective in Italy, it has not been widely adopted, including in Germany. This study retrospectively evaluates the protocol’s applicability and efficacy in a German cohort. Purpose This study aims to validate the Fast Italian Protocol's effectiveness in a German population and compare its diagnostic outcomes with Russo’s findings on both the Fast and Traditional Italian protocols. Methods This retrospective study, conducted at Klinikum Fuerth (Bavaria, Germany) between 2023 and 2024, applied the Fast Italian Protocol, with tilt-down triggered by presyncope, syncope, patient request, or at the test's end if negative. The protocol involved a 10-minute passive tilt at 70°, 0.3 mg nitroglycerin, and a 10-minute active phase. The standard protocol uses a 20-minute passive and 15-minute active phase. Positive responses included vasovagal syncope (cardioinhibitory, vasodepressor, mixed) or prolonged orthostatic hypotension. Hemodynamic data were recorded with a TaskForce monitor (CNSystem, Graz, Austria). Results A total of 45 patients (23 females, 22 males; age 26–87) participated. Negative results occurred in 46.7% (n=21), while 53.3% (n=24) were positive. Syncope or presyncope was observed in 6.7% during the passive phase and 46.7% post-nitroglycerin. Among positives, 17.8% (n=8) had vasodepressor syncope, 11.1% (n=5) cardioinhibitory, and 11.1% (n=5) mixed vasovagal syncope. Orthostatic responses were noted in 13.3% (n=6). Of all patients, 11.1% (n=5) received DDD pacemakers, and 11.1% (n=5) were considered for cardioneuroablation (CNA), with one patient undergoing CNA. Chi-square analysis revealed no significant difference in syncope distributions compared to Russo’s cohorts (p > 0.05). Conclusion These findings indicate that the Fast Italian Protocol, as developed by Russo, achieves diagnostic results comparable to those of Russo’s original cohort, supporting its effectiveness. The study further compared syncope type distribution with Russo’s traditional protocol. No statistically significant differences were observed, suggesting the Fast Italian Protocol may be a viable alternative without compromising diagnostic accuracy. The Fast Protocol uses the VASIS Classification, excluding orthostatic syncope, however, categorizing syncope as orthostatic or vasovagal did not impact diagnostic effectiveness. These results validate the Fast Italian Protocol and confirm its diagnostic reliability through independent replication and comparison with the original Italian cohort.