Tags

Type your tag names separated by a space and hit enter

Cardiovascular Autonomic Regulation, ETCO2 and the Heart Rate Response to the Tilt Table Test in Patients with Orthostatic Intolerance.
Appl Psychophysiol Biofeedback. 2022 06; 47(2):107-119.AP

Abstract

Chronic orthostatic intolerance (COI) is defined by changes in heart rate (HR), blood pressure (BP), respiration, symptoms of cerebral hypoperfusion and sympathetic overactivation. Postural tachycardia syndrome (POTS) is the most common form of COI in young adults and is defined by an orthostatic increase in heart rate (HR) of ≥ 30 bpm in the absence of orthostatic hypotension. However, some patients referred for evaluation of COI symptoms do not meet the orthostatic HR response criterion of POTS despite debilitating symptoms. Such patients are ill defined, posing diagnostic and therapeutic challenges. This study explored the relationship among cardiovascular autonomic control, the orthostatic HR response, EtCO2 and the severity of orthostatic symptoms and fatigue in patients referred for evaluation of COI. Patients (N = 108) performed standardized testing protocol of the Autonomic Reflex Screen and completed the Composite Autonomic Symptom Score (COMPASS-31) and the Fatigue Severity Scale (FSS). Greater severity of COI was associated with younger age, larger phase IV amplitude in the Valsalva maneuver and lower adrenal baroreflex sensitivity. Greater fatigue severity was associated with a larger reduction in ETCO2 during 10 min of head-up tilt (HUT) and reduced low-frequency (LF) power of heart rate variability. This study suggests that hemodynamic changes associated with the baroreflex response and changes in EtCO2 show a stronger association with the severity of orthostatic symptoms and fatigue than the overall orthostatic HR response in patients with COI.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Wheeler C
Division of Cardiology Clinical Research, Scripps Clinic, La Jolla, CA, 92037, USA.
Pacheco JM
Department of Applied and Integrated Neurosciences, Pontifical Catholic University of Puerto Rico, Ponce, PR, 00717, USA.
Kim AC
Vascular Laboratory, Scripps Clinic, La Jolla, CA, 92037, USA.
Camacho-Santiago M
Department of Psychology, Pontifical Catholic University of Puerto Rico, Ponce, PR, 00717, USA.
Kalafut MA
Division of Neurology, Autonomic Neuro Lab, Scripps Clinic, 9898 Genesee Ave., La Jolla, CA, 92037, USA.
Ahern T
Division of Cardiology, Scripps Clinic, La Jolla, CA, 92037, USA.
White AA
Division of Allergy/Immunology, Scripps Clinic, La Jolla, CA, 92037, USA.
Patay B
Division of Internal Medicine, Scripps Clinic, La Jolla, CA, 92037, USA.
Criado JR
Division of Neurology, Autonomic Neuro Lab, Scripps Clinic, 9898 Genesee Ave., La Jolla, CA, 92037, USA. criadodelvalle.jose@scrippshealth.org.

MeSH

Blood PressureFatigueHeart RateHumansOrthostatic IntolerancePostural Orthostatic Tachycardia SyndromeTilt-Table TestYoung Adult

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

35171410

Citation

Wheeler, Carmen, et al. "Cardiovascular Autonomic Regulation, ETCO2 and the Heart Rate Response to the Tilt Table Test in Patients With Orthostatic Intolerance." Applied Psychophysiology and Biofeedback, vol. 47, no. 2, 2022, pp. 107-119.
Wheeler C, Pacheco JM, Kim AC, et al. Cardiovascular Autonomic Regulation, ETCO2 and the Heart Rate Response to the Tilt Table Test in Patients with Orthostatic Intolerance. Appl Psychophysiol Biofeedback. 2022;47(2):107-119.
Wheeler, C., Pacheco, J. M., Kim, A. C., Camacho-Santiago, M., Kalafut, M. A., Ahern, T., White, A. A., Patay, B., & Criado, J. R. (2022). Cardiovascular Autonomic Regulation, ETCO2 and the Heart Rate Response to the Tilt Table Test in Patients with Orthostatic Intolerance. Applied Psychophysiology and Biofeedback, 47(2), 107-119. https://doi.org/10.1007/s10484-022-09536-4
Wheeler C, et al. Cardiovascular Autonomic Regulation, ETCO2 and the Heart Rate Response to the Tilt Table Test in Patients With Orthostatic Intolerance. Appl Psychophysiol Biofeedback. 2022;47(2):107-119. PubMed PMID: 35171410.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiovascular Autonomic Regulation, ETCO2 and the Heart Rate Response to the Tilt Table Test in Patients with Orthostatic Intolerance. AU - Wheeler,Carmen, AU - Pacheco,Jannay M, AU - Kim,Anna C, AU - Camacho-Santiago,Marisol, AU - Kalafut,Mary A, AU - Ahern,Thomas, AU - White,Andrew A, AU - Patay,Bradley, AU - Criado,José R, Y1 - 2022/02/16/ PY - 2022/01/31/accepted PY - 2022/2/17/pubmed PY - 2022/5/18/medline PY - 2022/2/16/entrez KW - Autonomic nervous system KW - EtCO2 KW - HRV KW - Head-up tilt KW - POTS KW - Valsalva maneuver SP - 107 EP - 119 JF - Applied psychophysiology and biofeedback JO - Appl Psychophysiol Biofeedback VL - 47 IS - 2 N2 - Chronic orthostatic intolerance (COI) is defined by changes in heart rate (HR), blood pressure (BP), respiration, symptoms of cerebral hypoperfusion and sympathetic overactivation. Postural tachycardia syndrome (POTS) is the most common form of COI in young adults and is defined by an orthostatic increase in heart rate (HR) of ≥ 30 bpm in the absence of orthostatic hypotension. However, some patients referred for evaluation of COI symptoms do not meet the orthostatic HR response criterion of POTS despite debilitating symptoms. Such patients are ill defined, posing diagnostic and therapeutic challenges. This study explored the relationship among cardiovascular autonomic control, the orthostatic HR response, EtCO2 and the severity of orthostatic symptoms and fatigue in patients referred for evaluation of COI. Patients (N = 108) performed standardized testing protocol of the Autonomic Reflex Screen and completed the Composite Autonomic Symptom Score (COMPASS-31) and the Fatigue Severity Scale (FSS). Greater severity of COI was associated with younger age, larger phase IV amplitude in the Valsalva maneuver and lower adrenal baroreflex sensitivity. Greater fatigue severity was associated with a larger reduction in ETCO2 during 10 min of head-up tilt (HUT) and reduced low-frequency (LF) power of heart rate variability. This study suggests that hemodynamic changes associated with the baroreflex response and changes in EtCO2 show a stronger association with the severity of orthostatic symptoms and fatigue than the overall orthostatic HR response in patients with COI. SN - 1573-3270 UR - https://www.unboundmedicine.com/medline/citation/35171410/Cardiovascular_Autonomic_Regulation_ETCO2_and_the_Heart_Rate_Response_to_the_Tilt_Table_Test_in_Patients_with_Orthostatic_Intolerance_ DB - PRIME DP - Unbound Medicine ER -