Orthostatic Changes in Hemodynamics and Cardiovascular Biomarkers in Dysautonomic Patients

Autor: Philippe Burri, Olle Melander, Richard Sutton, Widet Tas, David Nilsson, Artur Fedorowski
Jazyk: angličtina
Rok vydání: 2015
Předmět:
Tachycardia
Male
Orthostatic intolerance
Hemodynamics
lcsh:Medicine
Blood Pressure
Tilt table test
Orthostatic vital signs
Hypotension
Orthostatic
Heart Rate
Tilt-Table Test
HYPOTENSION
Odds Ratio
UNEXPLAINED SYNCOPE
Cardiac and Cardiovascular Systems
lcsh:Science
Multidisciplinary
medicine.diagnostic_test
NEURALLY-MEDIATED SYNCOPE
Middle Aged
Multidisciplinary Sciences
VASOVAGAL SYNCOPE
Cardiology
Science & Technology - Other Topics
Regression Analysis
Female
medicine.symptom
Neurohormones
Research Article
medicine.medical_specialty
General Science & Technology
Systole
HEAD-UP TILT
Primary Dysautonomias
NATRIURETIC-PEPTIDE
Syncope
Internal medicine
MD Multidisciplinary
Heart rate
Reflex
MANAGEMENT
medicine
Humans
HUMAN-PLASMA
Science & Technology
business.industry
lcsh:R
medicine.disease
Neurosecretory Systems
IMMUNOLUMINOMETRIC ASSAY
Blood pressure
lcsh:Q
business
NEUROCARDIOGENIC SYNCOPE
Biomarkers
Zdroj: PLoS ONE, Vol 10, Iss 6, p e0128962 (2015)
PLoS ONE
PLoS ONE; 10(6), no e0128962 (2015)
ISSN: 1932-6203
Popis: Background Impaired autonomic control of postural homeostasis results in orthostatic intolerance. However, the role of neurohormones in orthostatic intolerance has not been explained. Methods Six-hundred-and-seventy-one patients (299 males; 55±22 years) with unexplained syncope underwent head-up tilt (HUT) with serial blood sampling. Systolic blood pressure (SBP) and heart rate (HR) supine, after 3min, and lowest BP/highest HR during HUT were recorded. Plasma levels of epinephrine, norepinephrine, renin, C-terminal-pro-arginine-vasopressin (CT-proAVP), C-terminal- endothelin-1 (CT-proET-1), and mid-regional-fragment of pro-atrial-natriuretic-peptide (MR-proANP) were determined at supine and 3min of HUT. Multivariate-adjusted logistic regression model was applied to compare 1st (reference) with 4th quartile of 3 min and maximal ΔSBP/ΔHR (i.e. pronounced hypotension or tachycardia) vs. changes in neuroendocrine biomarkers, respectively. Results Higher resting CT-proET-1 predicted BP fall at 3min (Odds ratio (OR) per 1 SD: 1.62, 95% CI 1.18–2.22; p = 0.003), and max BP fall during HUT (1.82, 1.28–2.61; p = 0.001). Higher resting CT-proAVP predicted BP fall at 3min (1.33, 1.03–1.73; p = 0.03), which was also associated with increase in CT-proAVP (1.86, 1.38–2.51; p = 0.00005) and epinephrine (1.47, 1.12–1.92; p = 0.05) during HUT. Lower resting MR-proANP predicted tachycardia at 3min (0.37, 0.24–0.59; p = 0.00003), and max tachycardia during HUT (0.47, 0.29–0.77; p = 0.002). Further, tachycardia during HUT was associated with increase in epinephrine (1.60, 1.15–2.21; p = 0.005), and norepinephrine (1.87, 1.38–2.53; p = 0.005). Conclusions Resting CT-proET-1 and CT-proAVP are increased in orthostatic hypotension, while resting MR-proANP is decreased in postural tachycardia. Moreover, early BP fall during orthostasis evokes increase in CT-proAVP and epinephrine, while postural tachycardia is associated with increase in norepinephrine and epinephrine.
Databáze: OpenAIRE
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