Effects of Different Postures on the Hemodynamics and Cardiovascular Autonomic Control Responses to Exercise in Postural Orthostatic Tachycardia Syndrome

Overview

Journal Eur J Appl Physiol

Specialty Physiology

Date 2024 Nov 23

PMID 39580371

Authors

Carolina P Andrade

Antonio R Zamuner

Franca Barbic

Alberto Porta

Stefano Rigo

Dana A Shiffer

Aurelien Bringard

Nazzareno Fagoni

Guido Ferretti

Raffaello Furlan

Affiliations

Soon will be listed here.

Abstract

Purpose: To assess the effects of two different body positions on the cardiovascular autonomic profile during a single bout of exercise in patients with postural orthostatic tachycardia syndrome (POTS).

Methods: Thirteen patients with POTS and thirteen healthy controls (C) participated in the study. ECG, respiration, beat-by-beat arterial pressure and O consumption (VO2) were continuously recorded while on a cycle ergometer in supine and upright positions, before and during exercise (6 min, 50 Watts). Spectral analysis of RR intervals and systolic arterial pressure (SAP) variability provided indexes of cardiac sympathovagal interaction (LF/HF ratio), cardiac vagal modulation (HF, high-frequency component of RR variability, ~ 0.25 Hz), sympathetic vasomotor control (LF, low-frequency component of SAP variability, 0.1 Hz) and baroreflex sensitivity (BRS, α).

Results: While supine, patients with POTS showed lower HF and α, greater heart rate (HR), LF/HF and LF, compared with C, suggesting cardiovascular sympathetic over-activity and reduced BRS. While sitting upright, POTS showed greater HR and reduced HF and α compared with C. During supine exercise, SAP, HR, LF/HF increased and HF and α decreased similarly in POTS and C. In POTS, upright sitting exercise was associated with slightly higher , a greater increase in HR whereas LF was lower than in C.

Conclusion: Upright exercise was associated with excessive enhancement of HR and a blunted increase of the sympathetic vasomotor control in POTS. Conversely, supine exercise-induced hemodynamic and autonomic changes similar in POTS and C, thus making supine exercise potentially more suitable for physical rehabilitation in POTS.

References

Barbic F, Perego F, Canesi M, Gianni M, Biagiotti S, Costantino G . Early abnormalities of vascular and cardiac autonomic control in Parkinson's disease without orthostatic hypotension. Hypertension. 2006; 49(1):120-6. DOI: 10.1161/01.HYP.0000250939.71343.7c. View

Brilla L, Stephens A, Knutzen K, Caine D . Effect of strength training on orthostatic hypotension in older adults. J Cardiopulm Rehabil. 1998; 18(4):295-300. DOI: 10.1097/00008483-199807000-00007. View

Costantino G, Dipaola F, Selmi C, Furlan R . Orthostatic intolerance and coronary reserve: a matter of a certain gravity. Intern Emerg Med. 2010; 6(5):471-2. DOI: 10.1007/s11739-010-0488-0. View

Szijarto I, Marko L, Filipovic M, Miljkovic J, Tabeling C, Tsvetkov D . Cystathionine γ-Lyase-Produced Hydrogen Sulfide Controls Endothelial NO Bioavailability and Blood Pressure. Hypertension. 2018; 71(6):1210-1217. DOI: 10.1161/HYPERTENSIONAHA.117.10562. View

Diedrich A, Urechie V, Shiffer D, Rigo S, Minonzio M, Cairo B . Transdermal auricular vagus stimulation for the treatment of postural tachycardia syndrome. Auton Neurosci. 2021; 236:102886. PMC: 8939715. DOI: 10.1016/j.autneu.2021.102886. View

Barbic F, Minonzio M, Cairo B, Shiffer D, Zamuner A, Cavalieri S . Work Ability Assessment and Its Relationship with Cardiovascular Autonomic Profile in Postural Orthostatic Tachycardia Syndrome. Int J Environ Res Public Health. 2020; 17(21). PMC: 7662324. DOI: 10.3390/ijerph17217836. View

Fu Q, VanGundy T, Galbreath M, Shibata S, Jain M, Hastings J . Cardiac origins of the postural orthostatic tachycardia syndrome. J Am Coll Cardiol. 2010; 55(25):2858-68. PMC: 2914315. DOI: 10.1016/j.jacc.2010.02.043. View

Fu Q, VanGundy T, Shibata S, Auchus R, Williams G, Levine B . Exercise training versus propranolol in the treatment of the postural orthostatic tachycardia syndrome. Hypertension. 2011; 58(2):167-75. PMC: 3142863. DOI: 10.1161/HYPERTENSIONAHA.111.172262. View

10.

Fu Q, Levine B . Exercise in the postural orthostatic tachycardia syndrome. Auton Neurosci. 2014; 188:86-9. PMC: 4336603. DOI: 10.1016/j.autneu.2014.11.008. View

11.

Furlan R, Jacob G, Snell M, Robertson D, Porta A, Harris P . Chronic orthostatic intolerance: a disorder with discordant cardiac and vascular sympathetic control. Circulation. 1998; 98(20):2154-9. DOI: 10.1161/01.cir.98.20.2154. View

12.

Furlan R, Porta A, Costa F, Tank J, Baker L, SCHIAVI R . Oscillatory patterns in sympathetic neural discharge and cardiovascular variables during orthostatic stimulus. Circulation. 2000; 101(8):886-92. DOI: 10.1161/01.cir.101.8.886. View

13.

Furlan R, Barbic F, Casella F, Severgnini G, Zenoni L, Mercieri A . Neural autonomic control in orthostatic intolerance. Respir Physiol Neurobiol. 2009; 169 Suppl 1:S17-20. DOI: 10.1016/j.resp.2009.04.008. View

14.

Galbreath M, Shibata S, VanGundy T, Okazaki K, Fu Q, Levine B . Effects of exercise training on arterial-cardiac baroreflex function in POTS. Clin Auton Res. 2010; 21(2):73-80. DOI: 10.1007/s10286-010-0091-5. View

15.

George S, Bivens T, Howden E, Saleem Y, Galbreath M, Hendrickson D . The international POTS registry: Evaluating the efficacy of an exercise training intervention in a community setting. Heart Rhythm. 2015; 13(4):943-50. DOI: 10.1016/j.hrthm.2015.12.012. View

16.

Goldberger Z, Petek B, Brignole M, Shen W, Sheldon R, Solbiati M . ACC/AHA/HRS Versus ESC Guidelines for the Diagnosis and Management of Syncope: JACC Guideline Comparison. J Am Coll Cardiol. 2019; 74(19):2410-2423. DOI: 10.1016/j.jacc.2019.09.012. View

17.

Jacob G, Costa F, Shannon J, Robertson R, Wathen M, Stein M . The neuropathic postural tachycardia syndrome. N Engl J Med. 2000; 343(14):1008-14. DOI: 10.1056/NEJM200010053431404. View

18.

Kamiya A, Iwase S, Kitazawa H, Mano T, Vinogradova O, Kharchenko I . Baroreflex control of muscle sympathetic nerve activity after 120 days of 6 degrees head-down bed rest. Am J Physiol Regul Integr Comp Physiol. 2000; 278(2):R445-52. DOI: 10.1152/ajpregu.2000.278.2.R445. View

19.

Lambert E, Lambert G . Sympathetic dysfunction in vasovagal syncope and the postural orthostatic tachycardia syndrome. Front Physiol. 2014; 5:280. PMC: 4112787. DOI: 10.3389/fphys.2014.00280. View

20.

Levine B, Pawelczyk J, Ertl A, Cox J, Zuckerman J, Diedrich A . Human muscle sympathetic neural and haemodynamic responses to tilt following spaceflight. J Physiol. 2002; 538(Pt 1):331-40. PMC: 2290017. DOI: 10.1113/jphysiol.2001.012575. View

21.

Low P, Sandroni P, Joyner M, Shen W . Postural tachycardia syndrome (POTS). J Cardiovasc Electrophysiol. 2009; 20(3):352-8. PMC: 3904426. DOI: 10.1111/j.1540-8167.2008.01407.x. View