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Shali RK, Setarehdan SK, Seifi B. Functional near-infrared spectroscopy based blood pressure variations and hemodynamic activity of brain monitoring following postural changes: A systematic review. Physiol Behav 2024; 281:114574. [PMID: 38697274 DOI: 10.1016/j.physbeh.2024.114574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/03/2024] [Accepted: 04/26/2024] [Indexed: 05/04/2024]
Abstract
Postural change from supine or sitting to standing up leads to displacement of 300 to 1000 mL of blood from the central parts of the body to the lower limb, which causes a decrease in venous return to the heart, hence decrease in cardiac output, causing a drop in blood pressure. This may lead to falling down, syncope, and in general reducing the quality of daily activities, especially in the elderly and anyone suffering from nervous system disorders such as Parkinson's or orthostatic hypotension (OH). Among different modalities to study brain function, functional near-infrared spectroscopy (fNIRS) is a neuroimaging method that optically measures the hemodynamic response in brain tissue. Concentration changes in oxygenated hemoglobin (HbO2) and deoxygenated hemoglobin (HHb) are associated with brain neural activity. fNIRS is significantly more tolerant to motion artifacts compared to fMRI, PET, and EEG. At the same time, it is portable, has a simple structure and usage, is safer, and much more economical. In this article, we systematically reviewed the literature to examine the history of using fNIRS in monitoring brain oxygenation changes caused by sudden changes in body position and its relationship with the blood pressure changes. First, the theory behind brain hemodynamics monitoring using fNIRS and its advantages and disadvantages are presented. Then, a study of blood pressure variations as a result of postural changes using fNIRS is described. It is observed that only 58 % of the references concluded a positive correlation between brain oxygenation changes and blood pressure changes. At the same time, 3 % showed a negative correlation, and 39 % did not show any correlation between them.
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Affiliation(s)
- Roya Kheyrkhah Shali
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran.
| | - Seyed Kamaledin Setarehdan
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Behjat Seifi
- Faculty of Medical Science, University of Tehran, Tehran, Iran
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2
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Tsai Owens M, Fischer PR, Sim L, Kirsch A, Homan K, Zaccariello M, Sawchuk N, LeMahieu A, Geske J, Harbeck-Weber C. The Contribution of Psychological Symptoms to Cognitive Difficulties in Youth With Postural Orthostatic Tachycardia Syndrome and Chronic Pain. J Child Neurol 2024; 39:104-112. [PMID: 38751190 DOI: 10.1177/08830738241236815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Subjectively experienced cognitive difficulties are common in youth with postural orthostatic tachycardia syndrome. The pathophysiological and psychological contributions of these cognitive impairments remain unclear. METHOD Participants were 96 adolescents and young adults diagnosed with postural orthostatic tachycardia syndrome and admitted to an intensive pain treatment program. Participants completed cognitive assessment and measures of postural orthostatic tachycardia syndrome symptoms, pain intensity, pain catastrophizing, anxiety, depression, and functional disability. RESULTS Self-reported autonomic symptom intensity, but not severity of heart rate change, was associated with cognitive performance. Symptoms of depression were associated with decreases in most measures of cognitive functioning. Pain intensity, pain catastrophizing, and depression but not cognitive scores and physiological measures, were significant predictors of disability. CONCLUSION Depression appears to be a significant contributor to the cognitive difficulties in youth with postural orthostatic tachycardia syndrome. These findings highlight the importance of assessing and treating affective symptoms in this population along with medical and lifestyle approaches to treating postural orthostatic tachycardia syndrome symptoms.
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Affiliation(s)
- Michele Tsai Owens
- Department of Psychiatry and Psychology, Mayo Clinic Rochester, Rochester, MN, USA
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Philip R Fischer
- Department of Pediatric and Adolescent Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Leslie Sim
- Department of Psychiatry and Psychology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Alexandra Kirsch
- Department of Psychiatry and Psychology, Mayo Clinic Rochester, Rochester, MN, USA
- Department of Psychiatry and Behavioral Science, Northshore University Health System, Evanston, IL, USA
| | - Kendra Homan
- Department of Psychiatry and Psychology, Mayo Clinic Rochester, Rochester, MN, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Division of Behavioral and Clinical Psychology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael Zaccariello
- Department of Psychiatry and Psychology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Nicholas Sawchuk
- Department of Psychiatry and Psychology, Mayo Clinic Rochester, Rochester, MN, USA
- Center for Individualized Medicine, Mayo Clinic Rochester, USA
| | - Allison LeMahieu
- Department of Quantitative Health Sciences, Mayo Clinic Rochester, Rochester, MN, USA
| | - Jennifer Geske
- Department of Quantitative Health Sciences, Mayo Clinic Rochester, Rochester, MN, USA
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3
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Yuan P, Lian Z, Wang Y, Zhang C, Jin H, Du J, Huang Y, Liao Y. Poincaré plot can help predict the curative effect of metoprolol for pediatric postural orthostatic tachycardia syndrome. Front Neurosci 2023; 17:1280172. [PMID: 38033543 PMCID: PMC10682374 DOI: 10.3389/fnins.2023.1280172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/18/2023] [Indexed: 12/02/2023] Open
Abstract
Purpose To study whether a Poincaré plot can help predict the curative effect of metoprolol for postural orthostatic tachycardia syndrome (POTS) in children. Methods Pediatric patients with POTS who were administered metoprolol were retrospectively included. The collected data included general data (sex, age, height, weight, and body mass index), the manifestations and treatment (baseline orthostatic intolerance symptom score and course of metoprolol treatment), vital signs (supine heart rate [HR], supine blood pressure, and increased HR during the standing test), HR variability indexes (standard deviation of normal-to-normal intervals [SDNN]; standard deviation of the averages of normal-to-normal intervals [SDANN]; mean standard deviation of the NN intervals for each 5-min segment [SDNNI]; root mean square of the successive differences [rMSSD]; percentage of adjacent NN intervals that differ by >50 ms [pNN50]; triangular index; ultra-low [ULF], very low [VLF], low [LF], and high frequency [HF]; total power [TP]; and LF/HF ratio), and graphical parameters of the Poincaré plot (longitudinal axis [L], transverse axis [T], and L/T). Receiver operator characteristic curves were used to calculate the predictive function of the indexes with significant differences between patients who responded and those who did not. The index combination with the highest predictive value was obtained through series-parallel analysis. Results Overall, 40 responders and 23 non-responders were included. The L and T in the Poincaré plots and rMSSD, pNN50, HF, and TP of the HR variability data were significantly lower in participants who responded to metoprolol than in participants who did not (p < 0.001). The L/T of participants who responded to metoprolol was greater than that of non-responders (p < 0.001). Moreover, we noted a strong correlation between every two indexes among L, T, rMSSD, pNN50, HF, TP, and L/T (p < 0.05). T < 573.9 ms combined with L/T > 2.9 had the best performance for predicting the effectiveness of metoprolol, with a sensitivity of 85.0%, specificity of 82.6%, and accuracy of 84.1%. Conclusion In the Poincaré plot, a T < 573.9 ms combined with an L/T > 2.9 helps predict good outcomes of using metoprolol to treat pediatric POTS.
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Affiliation(s)
- Piaoliu Yuan
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhouhui Lian
- Wang Xuan Institute of Computer Science, Peking University, Beijing, China
| | - Yuanyuan Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Chunyu Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
| | - Yaqian Huang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ying Liao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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Pérez-Denia L, Claffey P, O'Reilly A, Delgado-Ortet M, Rice C, Kenny RA, Finucane C. Cerebral Oxygenation Responses to Standing in Young Patients with Vasovagal Syncope. J Clin Med 2023; 12:4202. [PMID: 37445237 DOI: 10.3390/jcm12134202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 07/15/2023] Open
Abstract
Vasovagal syncope (VVS) is common in young adults and is attributed to cerebral hypoperfusion. However, during active stand (AS) testing, only peripheral and not cerebral hemodynamic responses are measured. We sought to determine whether cerebral oxygenation responses to an AS test were altered in young VVS patients when compared to the young healthy controls. A sample of young healthy adults and consecutive VVS patients attending a Falls and Syncope unit was recruited. Continuous beat-to-beat blood pressure (BP), heart rate, near-infrared spectroscopy (NIRS)-derived tissue saturation index (TSI), and changes in concentration of oxygenated/deoxygenated Δ[O2Hb]/Δ[HHb] hemoglobin were measured. BP and NIRS-derived features included nadir, peak, overshoot, trough, recovery rate, normalized recovery rate, and steady-state. Multivariate linear regression was used to adjust for confounders and BP. In total, 13 controls and 27 VVS patients were recruited. While no significant differences were observed in the TSI and Δ[O2Hb], there was a significantly smaller Δ[HHb] peak-to-trough and faster Δ[HHb] recovery rate in VVS patients, independent of BP. A higher BP steady-state was observed in patients but did not remain significant after multiple comparison correction. Young VVS patients demonstrated a similar cerebral circulatory response with signs of altered peripheral circulation with respect to the controls, potentially due to a hyper-reactive autonomic nervous system. This study sets the grounds for future investigations to understand the role of cerebral regulation during standing in VVS.
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Affiliation(s)
- Laura Pérez-Denia
- School of Medicine, Trinity College Dublin, D02 K6K6 Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
- Department of Medical Physics, Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 C9X2 Dublin, Ireland
| | - Paul Claffey
- School of Medicine, Trinity College Dublin, D02 K6K6 Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
| | - Ailbhe O'Reilly
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
- Department of Bioengineering, School of Mechanical Engineering, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | | | - Ciara Rice
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
| | - Rose Anne Kenny
- School of Medicine, Trinity College Dublin, D02 K6K6 Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
| | - Ciarán Finucane
- School of Medicine, Trinity College Dublin, D02 K6K6 Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
- Department of Medical Physics, Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 C9X2 Dublin, Ireland
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Ranada SI, Lei LY, Baker J, Wilson R, Phillips AA, Sheldon RS, Raj SR. Is there a relationship between hypocapnia and tachycardia in postural orthostatic tachycardia syndrome (POTS)? A systematic review. Clin Auton Res 2023; 33:191-195. [PMID: 36705794 DOI: 10.1007/s10286-023-00928-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/20/2023] [Indexed: 01/28/2023]
Affiliation(s)
- Shaun I Ranada
- Department of Cardiac Sciences, University of Calgary, GAC70 HRIC Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.,Libin Cardiovascular Institute, University of Calgary, Calgary, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Lucy Y Lei
- Department of Cardiac Sciences, University of Calgary, GAC70 HRIC Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.,Libin Cardiovascular Institute, University of Calgary, Calgary, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jacquie Baker
- Department of Cardiac Sciences, University of Calgary, GAC70 HRIC Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.,Libin Cardiovascular Institute, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Richard Wilson
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Canada.,Libin Cardiovascular Institute, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Aaron A Phillips
- Department of Cardiac Sciences, University of Calgary, GAC70 HRIC Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.,Department of Physiology and Pharmacology, University of Calgary, Calgary, Canada.,Libin Cardiovascular Institute, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Robert S Sheldon
- Department of Cardiac Sciences, University of Calgary, GAC70 HRIC Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.,Libin Cardiovascular Institute, University of Calgary, Calgary, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Satish R Raj
- Department of Cardiac Sciences, University of Calgary, GAC70 HRIC Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada. .,Libin Cardiovascular Institute, University of Calgary, Calgary, Canada. .,Cumming School of Medicine, University of Calgary, Calgary, Canada.
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Ozturk ED, Iaccarino MA, Hamner JW, Aaron SE, Hunt DL, Meehan WP, Howell DR, Tan CO. Executive dysfunction after multiple concussions is not related to cerebrovascular dysfunction. Physiol Meas 2021; 42. [PMID: 34450608 DOI: 10.1088/1361-6579/ac2207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/27/2021] [Indexed: 11/11/2022]
Abstract
Objective.We investigated the relation between prior concussion history and working memory (WM), self-reported cognitive symptom burden, and cerebrovascular function in adolescents and young adults (14-21 years old).Approach.We recruited 59 participants, 34 clinically diagnosed with a sports-related concussion and 25 controls. Concussed subjects were studied at baseline (within 28 days of their injury) and eight weeks after, while control subjects only had one assessment. We assessed WM (n-back task up to four-back), and neurovascular coupling (cerebrovascular responses at middle cerebral artery duringn-back tasks) using a transcranial Doppler ultrasonograph.Main results.There was no significant difference in WM between controls and concussed participants (p = 0.402). However, WM capacity was lower in those who had sustained ≥3 concussions (7.1% with WM capacity of four) compared to those with their first ever concussion (33.3%) and controls (28.0%, overallp = 0.025). At the sub-acute point (n = 24), self-reported cognitive symptom burden was mostly resolved in all but two participants. Despite the resolution of symptoms, WM performance was not different eight weeks post injury (p = 0.706). Neurovascular coupling was not different between controls and concussed participants regardless of prior concussion history.Significance. Up to 20% of concussed individuals experience covert sequelae lasting beyond the resolution of self-reported overt symptoms. How a prior history of concussion impacts the potential for sequelae is not well established, and the underlying mechanisms are unknown. Despite no alterations in neurovascular coupling, a history of prior concussion was associated with significant deficits in WM capacity, and lasted beyond self-reported cognitive symptom resolution.
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Affiliation(s)
- Erin D Ozturk
- Cerebrovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, United States of America
| | - Mary Alexis Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States of America.,Spaulding Rehabilitation Hospital, Boston, MA, United States of America.,Massachusetts General Hospital for Children Sports Concussion Program, Boston, MA, United States of America
| | - Jason W Hamner
- Cerebrovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, United States of America
| | - Stacey E Aaron
- Cerebrovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, United States of America.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States of America
| | - Danielle L Hunt
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States of America.,The Micheli Center for Sports Injury Prevention, Waltham, MA, United States of America
| | - William P Meehan
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States of America.,The Micheli Center for Sports Injury Prevention, Waltham, MA, United States of America.,Departments of Orthopedic Surgery and Pediatrics, Harvard Medical School, Boston, MA, United States of America
| | - David R Howell
- The Micheli Center for Sports Injury Prevention, Waltham, MA, United States of America.,Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, United States of America.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Can Ozan Tan
- Cerebrovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, United States of America.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States of America.,Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, United States of America
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7
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Cardiovascular correlates of human emotional vasovagal syncope differ from those of animal freezing and tonic immobility. Physiol Behav 2021; 238:113463. [PMID: 34023376 DOI: 10.1016/j.physbeh.2021.113463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/24/2022]
Abstract
It has been suggested that vertebrate freezing and tonic immobility (TI) represent the antecedents of human emotional vasovagal syncope. When a prey detects an approaching predator, it suddenly interrupts its ongoing activity and behaves according to the predator's distance. A prey enters TI when the fight or flight reaction is not feasible and the animal is captured. TI is defined as a post-contact, all or none, innate immobility reflex response that persists after the end of the prey-predator contact. In humans, vasovagal syncope, a reversible adaptive response frequently associated with fainting, occurs in response to emergency conditions such as strong emotions, orthostatic stress, anoxia, visceral pain and decrease in blood volume. The aim of the present review is to dispute the hypothesis that human vasovagal syncope represents the evolution of the bradycardia observed during freezing in a prey-predator condition in other vertebrates. The hypothesis does not take into account three crucial issues: 1) freezing and TI are defence responses which differ from each other in behavioural, cardiovascular and neurophysiological correlates; 2) the initial phase of vasovagal syncope is associated with tachycardia, whereas freezing is associated with a sudden fast-developing bradycardia; 3) the second phase of vasovagal syncope terminates with a blood pressure collapse, whereas blood pressure levels remain at basal levels during both freezing and TI.
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Kharraziha I, Holm H, Bachus E, Melander O, Sutton R, Fedorowski A, Hamrefors V. Monitoring of cerebral oximetry in patients with postural orthostatic tachycardia syndrome. Europace 2020; 21:1575-1583. [PMID: 31384930 PMCID: PMC6877984 DOI: 10.1093/europace/euz204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/11/2019] [Indexed: 11/14/2022] Open
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.
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Affiliation(s)
| | - Hannes Holm
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Erasmus Bachus
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Richard Sutton
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,National Heart and Lung Institute, Imperial College, Hammersmith Hospital Campus, London, UK
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Viktor Hamrefors
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
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9
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Phillips Z, Kim JB, Paik SH, Kang SY, Jeon NJ, Kim BM, Kim BJ. Regional analysis of cerebral hemodynamic changes during the head-up tilt test in Parkinson's disease patients with orthostatic intolerance. NEUROPHOTONICS 2020; 7:045006. [PMID: 33163544 PMCID: PMC7595744 DOI: 10.1117/1.nph.7.4.045006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/16/2020] [Indexed: 06/11/2023]
Abstract
Significance: Cerebral oxygenation changes in the superior, middle, and medial gyri were used to elucidate spatial impairments of autonomic hemodynamic recovery during the head-up tilt table test (HUTT) in Parkinson's disease (PD) patients with orthostatic intolerance (OI) symptoms. Aim: To analyze dynamic oxygenation changes during the HUTT and classify PD patients with OI symptoms using clinical and oxygenation features. Approach: Thirty-nine PD patients with OI symptoms [10: orthostatic hypotension (PD-OH); 29: normal HUTT results (PD-NOR)] and seven healthy controls (HCs) were recruited. Prefrontal oxyhemoglobin (HbO) changes during the HUTT were reconstructed with diffuse optical tomography and segmented using the automated anatomical labeling system. Decision trees were used for classification. Results: HCs and PD-NOR patients with positive rates of HbO change (PD-POS) showed the greatest HbO recovery in the superior frontal gyrus (SFG) during tilt. PD-OH and PD-NOR patients with negative rates of HbO change (PD-NEG) showed asymmetric reoxygenation. The classification accuracy was 89.4% for PD-POS versus PD-NEG, 71% for PD-NOR versus PD-OH, and 55.8% for PD-POS versus PD-NEG versus PD-OH. The oxygenation features were more discriminative than the clinical features. Conclusions: PD-OH showed decreased right SFG function, which may be associated with impaired compensatory autonomic responses to orthostatic stress.
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Affiliation(s)
- Zephaniah Phillips
- Korea University, Department of Bio-Convergence Engineering, Seoul, Republic of Korea
| | - Jung Bin Kim
- Korea University Anam Hospital, Department of Neurology, Seoul, Republic of Korea
| | - Seung-Ho Paik
- Korea University, Department of Bio-Convergence Engineering, Seoul, Republic of Korea
- KLIEN Inc., Seoul Biohub, Seoul, Republic of Korea
| | - Shin-Young Kang
- Korea University, Department of Bio-Convergence Engineering, Seoul, Republic of Korea
| | - Nam-Joon Jeon
- Korea University Anam Hospital, Neurophysiology Laboratory, Seoul, Republic of Korea
| | - Beop-Min Kim
- Korea University, Department of Bio-Convergence Engineering, Seoul, Republic of Korea
| | - Byung-Jo Kim
- Korea University Anam Hospital, Department of Neurology, Seoul, Republic of Korea
- Korea University Anam Hospital, Brain Convergence Research Center, Seoul, Republic of Korea
- Korea University, BK21 FOUR Program in Learning Health Systems, Seoul, Republic of Korea
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10
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Kharraziha I, Holm H, Bachus E, Ricci F, Sutton R, Fedorowski A, Hamrefors V. Cerebral Oximetry in Syncope and Syndromes of Orthostatic Intolerance. Front Cardiovasc Med 2019; 6:171. [PMID: 31824964 PMCID: PMC6886369 DOI: 10.3389/fcvm.2019.00171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/08/2019] [Indexed: 11/26/2022] Open
Abstract
Cerebral autoregulation is crucial for maintaining cerebral blood flow and perfusion. In recent years, the importance of cerebral oxygenation in syncope and orthostatic intolerance (OI) has received increased attention. Cerebral tissue oxygenation can be measured by using near-infrared spectroscopy (NIRS), which determines the ratio of oxygenated hemoglobin to total hemoglobin in cerebral tissue. NIRS is non-invasive technology using near-infrared light, which displays real-time cerebral tissue oxygenation. Normal values of cerebral tissue oxygenation in healthy subjects are 60 to 80%. Head-up tilt test (HUT) offers the opportunity to observe the haemodynamic changes precipitating syncope and is, today, the standard method for the evaluation of syncope and orthostatic intolerance syndromes. In previous studies where NIRS was applied during HUT, a significant decrease in cerebral tissue oxygenation both prior to and during loss-of-consciousness in vasovagal syncope (VVS) has been observed. Interestingly, cerebral tissue oxygenation appears to decrease even before haemodynamic changes can be observed. Apart from VVS, cerebral tissue oxygenation decreases during orthostatic provocation in patients with orthostatic hypotension (OH) and postural orthostatic tachycardia syndrome (POTS), in the latter even in the absence of hypotension. Importantly, decline of cerebral tissue oxygenation in VVS and POTS during HUT may not correlate with hemodynamic changes. In this mini review, we summarize the current knowledge of the application of cerebral oximetry in syncope and orthostatic intolerance syndromes, discuss its likely value as a clinical diagnostic tool and also emphasize its potential in the understanding of the relevant pathophysiology.
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Affiliation(s)
- Isabella Kharraziha
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Hannes Holm
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Erasmus Bachus
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Fabrizio Ricci
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Institute of Cardiology, University "G. d'Annunzio", Chieti, Italy.,Department of Neuroscience and Imaging, ITAB - Institute Advanced Biomedical Technologies, University "G. d'Annunzio", Chieti, Italy
| | - Richard Sutton
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden.,National Heart and Lung Institute, Imperial College, Hammersmith Hospital, London, United Kingdom
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Viktor Hamrefors
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
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11
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Tao C, Chen S, Li H, Wang Y, Wang Y, Liu P, Liao Y, Zhang C, Tang C, Jin H, Du J. Value of Immediate Heart Rate Alteration From Supine to Upright in Differential Diagnosis Between Vasovagal Syncope and Postural Tachycardia Syndrome in Children. Front Pediatr 2018; 6:343. [PMID: 30510926 PMCID: PMC6252323 DOI: 10.3389/fped.2018.00343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/23/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives: To explore the predictive value of immediate heart rate alteration from supine to upright in the differential diagnosis between vasovagal syncope (VVS) and postural tachycardia syndrome (POTS) in children. Materials and Methods: A total of 76 pediatric outpatients or inpatients who visited the Peking University First Hospital from July 2016 to November 2017 were recruited in the study. Among them, 52 patients were diagnosed with VVS and 24 patients were diagnosed with POTS. The differential diagnostic value of acceleration index (AI) and 30/15 ratio was evaluated by the receiver operating characteristic (ROC) curve. An external validation test was performed in another 46 patients. Results: Compared with the cases in the VVS group, patients in the POTS group had a significantly increased AI but a decreased 30/15 ratio (33.495 ± 8.472 vs. 23.440 ± 8.693, p < 0.001; 0.962 ± 0.067 vs. 1.025 ± 0.084, p = 0.002; respectively). The ROC curves showed that AI and 30/15 ratio were useful for differentiating POTS from VVS. A cut-off value of AI set at 28.180 yielded a sensitivity of 79.2% and a specificity of 73.1%. A cut-off value of 30/15 ratio set at 1.025 yielded a sensitivity of 87.5% and a specificity of 61.5%. A combined use of these two indices improved the sensitivity to 95.8% when either AI or 30/15 was used, and specificity to 80.8% with the use of both AI and 30/15 at the same diagnosis. The external validation test showed that the positive and negative predictive values of the AI and 30/15 ratio were 77.3 and 79.2%, and 72.0 and 81.0%, respectively. The positive predictive value increased to 87.5% when both the AI and 30/15 ratio cut-off values were used together. Conclusions: The AI and 30/15 ratio, which are easy to perform and non-invasive, have proper sensitivity and specificity to differentiate patients with POTS from those with VVS. The combination of these two indices significantly improves the predictive value.
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Affiliation(s)
- Chunyan Tao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Selena Chen
- Division of Biological Sciences, University of California, San Diego, San Diego, CA, United States
| | - Hongxia Li
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yuanyuan Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yuli Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ping Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ying Liao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Chunyu Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Chaoshu Tang
- Department of Physiology and Pathophysiology, Peking University Health Sciences Centre, Beijing, China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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12
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Medow MS, Kothari ML, Goetz AM, O'Donnell-Smith MB, Terilli C, Stewart JM. Decreasing cerebral oxygen consumption during upright tilt in vasovagal syncope. Physiol Rep 2018; 5:e13286. [PMID: 28554964 PMCID: PMC5449565 DOI: 10.14814/phy2.13286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 11/24/2022] Open
Abstract
We measured changes in transcranial Doppler ultrasound (TCD) and near infrared spectroscopy (NIRS) during 70° upright tilt in patients with recurrent vasovagal syncope (VVS, N = 20), postural tachycardia syndrome (POTS, N = 20), and healthy controls (N = 12) aged 15–27 years old. VVS was included if they fainted during testing within 5–15 min of upright tilt. We combined TCD and NIRS to obtain estimates of percent change in the cerebral metabolic rate of oxygen consumption (CMRO2), cerebral blood flow velocity (CBFv), and oxygen extraction fraction (OEF). Over the course of 10 min of upright tilt, CBFv decreased from a baseline of 70 ± 5 to 63 ± 5 cm/sec in controls and 74 ± 3 to 64 ± 3 cm/sec in POTS while decreasing from 74 ± 4 to 44 ± 3 cm/sec in VVS. CMRO2 was unchanged in POTS and controls during tilt while OEF increased by 19 ± 3% and 15 ± 3%, respectively. CMRO2 decreased by 31 ± 3% in VVS during tilt while OEF only increased by 7 ± 3%. Oxyhemoglobin decreased by 1.1 ± 1.3 μmol/kg brain tissue in controls, by 1.1 ± 1.3 μmol/kg in POTS, and 11.1 ± 1.3 μmol/kg in VVS. CBFv and CMRO2 fell steadily in VVS during upright tilt. The deficit in CMRO2 in VVS results from inadequate OEF in the face of greatly reduced CBF.
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Affiliation(s)
- Marvin S Medow
- Departments of Pediatrics and Physiology, New York Medical College, Center for Hypotension, Hawthorne, New York
| | - Mira L Kothari
- Departments of Pediatrics and Physiology, New York Medical College, Center for Hypotension, Hawthorne, New York
| | - Amanda M Goetz
- Departments of Pediatrics and Physiology, New York Medical College, Center for Hypotension, Hawthorne, New York
| | - Mary Breige O'Donnell-Smith
- Departments of Pediatrics and Physiology, New York Medical College, Center for Hypotension, Hawthorne, New York
| | - Courtney Terilli
- Departments of Pediatrics and Physiology, New York Medical College, Center for Hypotension, Hawthorne, New York
| | - Julian M Stewart
- Departments of Pediatrics and Physiology, New York Medical College, Center for Hypotension, Hawthorne, New York
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