Accuracy and mean duration of different protocols of head-up tilt testing.

Based on the results of our study, > 95% of patients with a positive passive tilt test are also positive during 3 micrograms/min, and especially 5 micrograms/min, isoproterenol tilt test. A proposed time-saving protocol would be to initiate the test with an isoproterenol infusion and to perform a 45-minute passive tilt only in those patients with a positive 5 micrograms/min (an infusion rate reported to have an excessive low specificity) isoproterenol tilt test, and to consider only those with symptoms associated with objective changes during this latter test as "finally positive." An alternative option would be to perform a 45-minute passive tilt only in those patients with a negative 3 micrograms/min isoproterenol tilt test.