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Monitoring of cerebral oximetry in patients with postural orthostatic tachycardia syndrome.
Europace. 2019 Oct 01; 21(10):1575-1583.E

Abstract

AIMS

Postural orthostatic tachycardia syndrome (POTS) is a disorder of unknown aetiology characterized by orthostatic intolerance and tachycardia with diverse other symptoms, including neurocognitive deficits. Cerebral oximetry non-invasively measures cerebral tissue saturation (SctO2) and has been shown to be informative in syncope evaluation. We aimed to assess SctO2 in POTS patients and those with normal response to orthostatic provocation, relative to haemodynamic parameters and symptoms.

METHODS AND RESULTS

Thirty-four patients with POTS (29.1 ± 9.5 years; 26 females) and 34 age-/sex-matched controls with normal head-up tilt tests (HUTs) were included. SctO2 at rest and during HUT were compared between POTS and controls. The relation between SctO2, systolic blood pressure (SBP), and heart rate (HR) during HUT was linearly assessed. SctO2 values were related to dizziness or syncope during HUT. The minimum SctO2-value during HUT was lower (65.4 ± 5.6 vs. 68.2 ± 4.2%, P = 0.023) and changes in SctO2 from supine to minimum HUT value were more pronounced in POTS patients (-5.7 ± 2.9% vs. -4.3 ± 2.1%, P = 0.028). Decrease in SBP from supine to minimum HUT value (P = 0.004) and increase in HR from supine to HUT value at 3 min (P = 0.022) correlated with more pronounced SctO2 decrease in POTS but not controls. SctO2 did not predict syncope or dizziness during HUT.

CONCLUSION

Postural orthostatic tachycardia syndrome patients have lower cerebral tissue saturation during orthostatic provocation compared with those subjects having normal haemodynamic response to tilt. Orthostatic decrease in cerebral saturation only weakly correlates with HR increase and does not predict vasovagal reflex in POTS. Other hitherto unknown factors may affect cerebral tissue saturation in POTS.

Authors+Show Affiliations

Department of Clinical Sciences, Lund University, Malmö, Sweden.Department of Clinical Sciences, Lund University, Malmö, Sweden. Department of Cardiology, Skåne University Hospital, Malmö, Sweden.Department of Clinical Sciences, Lund University, Malmö, Sweden.Department of Clinical Sciences, Lund University, Malmö, Sweden. Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.Department of Clinical Sciences, Lund University, Malmö, Sweden. National Heart and Lung Institute, Imperial College, Hammersmith Hospital Campus, London, UK.Department of Clinical Sciences, Lund University, Malmö, Sweden. Department of Cardiology, Skåne University Hospital, Malmö, Sweden.Department of Clinical Sciences, Lund University, Malmö, Sweden. Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31384930

Citation

Kharraziha, Isabella, et al. "Monitoring of Cerebral Oximetry in Patients With Postural Orthostatic Tachycardia Syndrome." Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups On Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, vol. 21, no. 10, 2019, pp. 1575-1583.
Kharraziha I, Holm H, Bachus E, et al. Monitoring of cerebral oximetry in patients with postural orthostatic tachycardia syndrome. Europace. 2019;21(10):1575-1583.
Kharraziha, I., Holm, H., Bachus, E., Melander, O., Sutton, R., Fedorowski, A., & Hamrefors, V. (2019). Monitoring of cerebral oximetry in patients with postural orthostatic tachycardia syndrome. Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups On Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, 21(10), 1575-1583. https://doi.org/10.1093/europace/euz204
Kharraziha I, et al. Monitoring of Cerebral Oximetry in Patients With Postural Orthostatic Tachycardia Syndrome. Europace. 2019 Oct 1;21(10):1575-1583. PubMed PMID: 31384930.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Monitoring of cerebral oximetry in patients with postural orthostatic tachycardia syndrome. AU - Kharraziha,Isabella, AU - Holm,Hannes, AU - Bachus,Erasmus, AU - Melander,Olle, AU - Sutton,Richard, AU - Fedorowski,Artur, AU - Hamrefors,Viktor, PY - 2018/12/21/received PY - 2019/7/11/accepted PY - 2019/8/7/pubmed PY - 2020/10/29/medline PY - 2019/8/7/entrez KW - Cerebral oximetry KW - Haemodynamic monitoring KW - Head-up tilt KW - Orthostatic intolerance KW - Postural orthostatic tachycardia syndrome SP - 1575 EP - 1583 JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology JO - Europace VL - 21 IS - 10 N2 - AIMS: Postural orthostatic tachycardia syndrome (POTS) is a disorder of unknown aetiology characterized by orthostatic intolerance and tachycardia with diverse other symptoms, including neurocognitive deficits. Cerebral oximetry non-invasively measures cerebral tissue saturation (SctO2) and has been shown to be informative in syncope evaluation. We aimed to assess SctO2 in POTS patients and those with normal response to orthostatic provocation, relative to haemodynamic parameters and symptoms. METHODS AND RESULTS: Thirty-four patients with POTS (29.1 ± 9.5 years; 26 females) and 34 age-/sex-matched controls with normal head-up tilt tests (HUTs) were included. SctO2 at rest and during HUT were compared between POTS and controls. The relation between SctO2, systolic blood pressure (SBP), and heart rate (HR) during HUT was linearly assessed. SctO2 values were related to dizziness or syncope during HUT. The minimum SctO2-value during HUT was lower (65.4 ± 5.6 vs. 68.2 ± 4.2%, P = 0.023) and changes in SctO2 from supine to minimum HUT value were more pronounced in POTS patients (-5.7 ± 2.9% vs. -4.3 ± 2.1%, P = 0.028). Decrease in SBP from supine to minimum HUT value (P = 0.004) and increase in HR from supine to HUT value at 3 min (P = 0.022) correlated with more pronounced SctO2 decrease in POTS but not controls. SctO2 did not predict syncope or dizziness during HUT. CONCLUSION: Postural orthostatic tachycardia syndrome patients have lower cerebral tissue saturation during orthostatic provocation compared with those subjects having normal haemodynamic response to tilt. Orthostatic decrease in cerebral saturation only weakly correlates with HR increase and does not predict vasovagal reflex in POTS. Other hitherto unknown factors may affect cerebral tissue saturation in POTS. SN - 1532-2092 UR - https://www.unboundmedicine.com/medline/citation/31384930/Monitoring_of_cerebral_oximetry_in_patients_with_postural_orthostatic_tachycardia_syndrome_ DB - PRIME DP - Unbound Medicine ER -