Can standing replace upright tilt table testing in the diagnosis of postural tachycardia syndrome (POTS) in the young?

IF 3.9 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Autonomic Research Pub Date : 2024-11-26 DOI:10.1007/s10286-024-01080-x

Julian M Stewart, Marvin S Medow

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Abstract

Purpose: We compared standing and upright tilt in patients with postural tachycardia syndrome (POTS) and healthy volunteers to determine whether standing accurately tests for POTS in youngsters < 19 years. POTS in adolescents is defined by orthostatic intolerance plus sustained excessive upright tachycardia, without hypotension during upright tilt. We examined whether active standing is a valid classifier for POTS in adolescents compared to tilt.

Methods: Patients with POTS (N = 36, 12.2-18.8 years) and healthy volunteers (N = 39, 13.1-18.9 years) performed stand for a minimum of 5-min and were tilted to 70° for 10 min. Receiver operating characteristics analyses (ROC) were performed at 5-min stand, and at 5 and 10 min tilt for optimal threshold for heart rate (HR) increase (ΔHR), and test sensitivity and specificity.

Results: Most subjects were unable to stand for 10 min. ΔHRs at 5 min stand were higher in POTS (31 ± 3) compared with control (21 ± 2) and elevated at 5- or 10-min tilt in POTS (51 ± 3 and 51 ± 2) versus control (26 ± 2 and 25 ± 2) compared with standing. ΔHR in POTS and controls for 10 min were not different from 5 min. For 5 min stand ROC threshold was 26 beats per min (bpm), sensitivity of 70.6%, and specificity of 68.2% compared with 39 bpm, 88.2%, and 95.1% for 5 min tilt, and 40 bpm, 94.1%, and 95.1% for 10-min tilt. A precision-recall graph confirmed the superior discriminating ability of 5 min and 10 min tilt compared to 5 min stand.

Conclusions: The stand test is relatively non-specific and imprecise compared to tilt and does not satisfactorily distinguish POTS from control in patients aged < 19 years old.

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在诊断年轻人体位性心动过速综合征（POTS）时，站立能否取代直立倾斜台试验？

目的：我们比较了体位性心动过速综合征（POTS）患者和健康志愿者的站立和直立倾斜，以确定站立是否能准确测试青少年的 POTS：POTS患者（36人，12.2-18.8岁）和健康志愿者（39人，13.1-18.9岁）进行至少5分钟的站立和10分钟的70°倾斜。对站立 5 分钟、倾斜 5 分钟和 10 分钟时心率（HR）增加的最佳阈值（ΔHR）以及测试灵敏度和特异性进行了接收器操作特性分析（ROC）：与对照组（21±2）相比，POTS 患者站立 5 分钟时的ΔHR 较高（31±3）；与对照组（26±2 和 25±2）相比，POTS 患者倾斜 5 或 10 分钟时的ΔHR 较高（51±3 和 51±2）。POTS 和对照组在 10 分钟内的ΔHR 与 5 分钟内的ΔHR 没有差异。站立 5 分钟的 ROC 阈值为每分钟 26 次（bpm），灵敏度为 70.6%，特异度为 68.2%；而倾斜 5 分钟的 ROC 阈值为每分钟 39 次（bpm），灵敏度为 88.2%，特异度为 95.1%；倾斜 10 分钟的 ROC 阈值为每分钟 40 次（bpm），灵敏度为 94.1%，特异度为 95.1%。精确度-回忆图证实，与 5 分钟站立相比，5 分钟和 10 分钟倾斜的分辨能力更强：结论：站立测试与倾斜测试相比缺乏特异性且不精确，不能很好地区分老年 POTS 患者和对照组患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Autonomic Research 医学-临床神经学

CiteScore

7.40

自引率

6.90%

发文量

审稿时长

>12 weeks

期刊介绍： Clinical Autonomic Research aims to draw together and disseminate research work from various disciplines and specialties dealing with clinical problems resulting from autonomic dysfunction. Areas to be covered include: cardiovascular system, neurology, diabetes, endocrinology, urology, pain disorders, ophthalmology, gastroenterology, toxicology and clinical pharmacology, skin infectious diseases, renal disease. This journal is an essential source of new information for everyone working in areas involving the autonomic nervous system. A major feature of Clinical Autonomic Research is its speed of publication coupled with the highest refereeing standards.