PMID- 37104891
OWN - NLM
STAT- MEDLINE
DCOM- 20230522
LR  - 20230623
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 197
DP  - 2023 Jun 15
TI  - Distinct Hemodynamic Responses That Culminate With Postural Orthostatic 
      Tachycardia Syndrome.
PG  - 3-12
LID - S0002-9149(23)00180-7 [pii]
LID - 10.1016/j.amjcard.2023.03.027 [doi]
AB  - It is of paramount importance to characterize the individual hemodynamic response 
      of patients with postural orthostatic tachycardia syndrome (POTS) to select the 
      best therapeutic intervention. Our aim in this study was to describe the 
      hemodynamic changes in 40 patients with POTS during the head-up tilt test and 
      compare them with 48 healthy patients. Hemodynamic parameters were obtained by 
      cardiac bioimpedance. Patients were compared in supine position and after 5, 10, 
      15, and 20 minutes of orthostatic position. Patients with POTS demonstrated 
      higher heart rate (74 beats per minute [64 to 80] vs 67 [62 to 72], p <0.001) and 
      lower stroke volume (SV) (83.0 ml [72 to 94] vs 90 [79 to 112], p <0.001) at 
      supine position. The response to orthostatic challenge was characterized by a 
      decrease in SV index (SVI) in both groups (DeltaSVI in ml/m(2): -16 [-25 to -7.] vs 
      -11 [-17 to -6.1], p = NS). Peripheral vascular resistance (PVR) was reduced only 
      in POTS (DeltaPVR in dyne.seg/cm(5):-52 [-279 to 163] vs 326 [58 to 535], p <0.001). 
      According to the best cut-off points obtained using the receiver operating 
      characteristic analysis for the variation of SVI (-15.5%) and PVR index (PVRI) 
      (-5.5%), we observed 4 distinct groups of POTS: 10% presented an increase in both 
      SVI and PVRI after the orthostatic challenge, 35% presented a PVRI decrease with 
      SVI maintenance or increase, 37.5% presented an SVI decrease with PVRI 
      maintenance or elevation, and 17.5% presented a reduction in both variables. Body 
      mass index, DeltaSVI, and DeltaPVRI were strongly correlated with POTS (area under the 
      curve = 0.86 [95% confidence interval 0.77 to 0.92], p <0.0001). In conclusion, 
      the use of appropriate cut-off points for hemodynamic parameters using 
      bioimpedance cardiography during the head-up tilt test could be a useful strategy 
      to identify the main mechanism involved and to select the best individual 
      therapeutic strategy in POTS.
CI  - Copyright (c) 2023 Elsevier Inc. All rights reserved.
FAU - de Oliveira, Mariana de Cassia Silva
AU  - de Oliveira MCS
AD  - Postgraduate Program in Internal Medicine, Internal Medicine Department, Federal 
      University of Parana, Curitiba, Parana, Brazil.
FAU - Tavora-Mehta, Maria Zildany P
AU  - Tavora-Mehta MZP
AD  - Postgraduate Program in Internal Medicine, Internal Medicine Department, Federal 
      University of Parana, Curitiba, Parana, Brazil.
FAU - Mehta, Niraj
AU  - Mehta N
AD  - Postgraduate Program in Internal Medicine, Internal Medicine Department, Federal 
      University of Parana, Curitiba, Parana, Brazil.
FAU - Magajevski, Adriano Senter
AU  - Magajevski AS
AD  - Postgraduate Program in Internal Medicine, Internal Medicine Department, Federal 
      University of Parana, Curitiba, Parana, Brazil.
FAU - Concato, Leticia
AU  - Concato L
AD  - Postgraduate Program in Internal Medicine, Internal Medicine Department, Federal 
      University of Parana, Curitiba, Parana, Brazil.
FAU - Ortiz, Marcio Rogerio
AU  - Ortiz MR
AD  - Postgraduate Program in Internal Medicine, Internal Medicine Department, Federal 
      University of Parana, Curitiba, Parana, Brazil.
FAU - Doubrawa, Eduardo
AU  - Doubrawa E
AD  - Postgraduate Program in Internal Medicine, Internal Medicine Department, Federal 
      University of Parana, Curitiba, Parana, Brazil.
FAU - Lofrano-Alves, Marco Stephan
AU  - Lofrano-Alves MS
AD  - Postgraduate Program in Internal Medicine, Internal Medicine Department, Federal 
      University of Parana, Curitiba, Parana, Brazil. Electronic address: 
      mslalves@hotmail.com.
LA  - eng
PT  - Journal Article
DEP - 20230425
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
SB  - IM
MH  - Humans
MH  - *Postural Orthostatic Tachycardia Syndrome
MH  - Blood Pressure/physiology
MH  - Hemodynamics/physiology
MH  - Heart Rate/physiology
MH  - Vascular Resistance
EDAT- 2023/04/27 18:41
MHDA- 2023/05/22 06:42
CRDT- 2023/04/27 18:00
PHST- 2022/11/30 00:00 [received]
PHST- 2023/03/08 00:00 [revised]
PHST- 2023/03/26 00:00 [accepted]
PHST- 2023/05/22 06:42 [medline]
PHST- 2023/04/27 18:41 [pubmed]
PHST- 2023/04/27 18:00 [entrez]
AID - S0002-9149(23)00180-7 [pii]
AID - 10.1016/j.amjcard.2023.03.027 [doi]
PST - ppublish
SO  - Am J Cardiol. 2023 Jun 15;197:3-12. doi: 10.1016/j.amjcard.2023.03.027. Epub 2023 
      Apr 25.