Clinical Autonomic Research最新文献

{"title":"Resting sympathetic transduction in veterans with PTSD.","authors":"Matias G Zanuzzi, Jeann L Sabino-Carvalho, Melissa J McGranahan, Jeanie Park","doi":"10.1007/s10286-026-01234-z","DOIUrl":"https://doi.org/10.1007/s10286-026-01234-z","url":null,"abstract":"<p><strong>Purpose: </strong>Posttraumatic stress disorder (PTSD) is associated with autonomic dysregulation characterized by heightened sympathetic nervous system and reduced parasympathetic nervous system activity that contribute to increased cardiovascular risk. Prior work has shown that individuals with PTSD have augmented increases in muscle sympathetic nerve activity (MSNA) during sympathoexcitatory stressors and increased vascular alpha-1 adrenergic receptor sensitivity. However, sympathetic transduction, defined as the blood pressure (BP) response to MSNA, has not been previously examined in PTSD. We investigated whether resting sympathetic transduction is increased in combat veterans with PTSD.</p><p><strong>Methods: </strong>In 18 veterans with PTSD and 10 age-matched controls, beat-to-beat blood pressure (finger photoplethysmography), heart rate (electrocardiography), and MSNA (microneurography) were recorded at rest for 10 min. Sympathetic BP transduction was quantified using signal averaging, whereby the BP response to each MSNA burst was tracked over 15 cardiac cycles and averaged to derive the peak change in BP.</p><p><strong>Results: </strong>Baseline characteristics, resting MSNA, BP, and heart rate were similar between groups. Sympathetic transduction did not differ between veterans with PTSD and controls (1.16 ± 0.74 vs 1.04 ± 0.67 mmHg; p = 0.67). In the PTSD group, resting MSNA was inversely associated with sympathetic transduction (r = - 0.494, p = 0.037). No associations were found with PTSD symptom severity or psychiatric comorbidities and sympathetic transduction.</p><p><strong>Conclusion: </strong>These findings suggest that resting sympathetic transduction is not altered in veterans with PTSD.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cutaneous alpha-synuclein deposition informs autonomic function in individuals with early-stage multiple system atrophy.","authors":"Paula Trujillo, Leah Mann, Bailey Bellaire, Roy Freeman, Todd Levine, Christopher H Gibbons, Amy Cooper, Cynthia Wong, David Stamler, Daniel O Claassen","doi":"10.1007/s10286-026-01235-y","DOIUrl":"10.1007/s10286-026-01235-y","url":null,"abstract":"<p><strong>Purpose: </strong>Multiple system atrophy is a progressive neurodegenerative disorder characterized by autonomic failure, parkinsonism, and cerebellar ataxia. Phosphorylated alpha-synuclein in skin nerves has emerged as a promising biomarker, but longitudinal studies remain limited. This study evaluated changes in cutaneous alpha-synuclein deposition over time, its association with autonomic dysfunction, and its concordance with seed amplification assay findings.</p><p><strong>Methods: </strong>Seventeen participants with probable multiple system atrophy were followed up for 12 months with clinical assessments, skin biopsies from posterior cervical and distal thigh regions, standardized orthostatic vital signs, and cerebrospinal fluid biomarker collection. Phosphorylated alpha-synuclein deposition was quantified using immunofluorescence microscopy and correlated with autonomic measures and seed amplification assay results.</p><p><strong>Results: </strong>Cutaneous alpha-synuclein deposition increased from baseline to the12-month follow-up visit. Total deposition was associated with orthostatic systolic blood pressure drop (p = 0.80, p = 0.0001) and with higher scores on the Orthostatic Hypotension Questionnaire and Composite Autonomic Symptom Score. Posterior cervical deposition showed stronger autonomic associations than distal thigh deposition. No associations were found with global disease severity or neurofilament light chain levels. Two participants with negative seed amplification assay results showed phosphorylated alpha-synuclein on skin biopsy.</p><p><strong>Conclusion: </strong>In this cohort, cutaneous phosphorylated alpha-synuclein increased over time and correlated with objective orthostatic hypotension and autonomic symptom burden in early synucleinopathy. Skin biopsy may serve as a minimally invasive tool to support diagnosis, monitor progression, and stratify clinical trial participants.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148719865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic strategies, test accuracy, and misdiagnosis of POTS: a narrative review of diagnostic criteria, tests, and diagnostic delay.","authors":"Maurice Tiotsop, Douni Roger, Renguh Sama, Eesha Ande, Joshua Salabei","doi":"10.1007/s10286-026-01233-0","DOIUrl":"https://doi.org/10.1007/s10286-026-01233-0","url":null,"abstract":"<p><strong>Purpose: </strong>Postural orthostatic tachycardia syndrome is defined by a sustained heart rate increment upon upright posture without orthostatic hypotension. Despite established criteria, the condition remains frequently underdiagnosed. This narrative review evaluates diagnostic strategies, test accuracy, diagnostic delay, and misdiagnosis patterns.</p><p><strong>Methods: </strong>Following prospective registration in PROSPERO (CRD 1248964), 7 databases were searched without date restriction. Eligible studies enrolled individuals aged 12 years or older undergoing evaluation for postural orthostatic tachycardia syndrome and reported diagnostic accuracy, criteria performance, or delay and misdiagnosis data. Dual-reviewer screening and standardized data extraction were performed. Risk of bias was assessed using QUADAS-2 and ROBINS-I. Narrative synthesis followed PRISMA 2020 guidelines.</p><p><strong>Results: </strong>In total, 26 studies met inclusion criteria, enrolling more than 30,000 participants across multiple countries. Diagnostic criteria varied in heart rate thresholds, tilt angle, and test duration. Abbreviated 2-min tilt testing missed 55% of confirmed cases (95% confidence interval 48-63%). Active standing tests achieved areas under the curve of 0.855-0.925 with time-of-day-standardized thresholds. Tachycardia mimicking the syndrome occurred in 26-44% of vasovagal syncope patients during tilt. Two large surveys (n = 13,754) documented a median diagnostic delay of 24 months; approximately 75-76% reported prior misdiagnosis, most frequently attributed to psychological or psychiatric conditions.</p><p><strong>Conclusions: </strong>Postural orthostatic tachycardia syndrome diagnosis is compromised by protocol heterogeneity, abbreviated testing, physiological mimicry, and a pattern of psychiatric misattribution. Standardization of tilt and standing test protocols, clinician education, and structured diagnostic pathways are warranted.</p><p><strong>Trial registration: </strong>PROSPERO Registration: CRD1248964.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of carotid sinus hypersensitivity in patients with suspected reflex syncope.","authors":"Michele Brignole, J Gert van Dijk, Artur Fedorowski, Frederik J De Lange","doi":"10.1007/s10286-026-01209-0","DOIUrl":"10.1007/s10286-026-01209-0","url":null,"abstract":"<p><strong>Purpose: </strong>To elucidate the pathophysiology of the carotid sinus reflex in a large cohort of patients with suspected reflex syncope.</p><p><strong>Method: </strong>We reviewed an electronic database of patients with suspected reflex syncope who underwent carotid sinus massage. The diagnostic protocol included both right and left massage, in supine and upright positions, followed by tilt testing.</p><p><strong>Results: </strong>The cohort included 2249 patients (52% male), median age 73 years. The conventional abnormality threshold of a maximum RR interval ≥ 3000 ms was present in 14.7% of patients and of a systolic blood pressure fall > 50 mmHg in 14.3% of patients. Abnormal responses occurred more frequently on the right side than the left side, and more during upright than supine testing. A second abnormal test occurred more often ipsilaterally. The extent of the maximum RR interval elicited by massage was independent of the baseline RR interval, whereas the difference in systolic blood pressure fall increased markedly with higher baseline values. The occurrence and severity of cardioinhibition and vasodepression increased with age, beginning at 40 years. Abnormal RR intervals and blood pressure drops were observed more frequently in men than in women. Additionally, there was only a limited correlation between positive responses to carotid massage and tilt testing concerning asystole and blood pressure reduction.</p><p><strong>Conclusion: </strong>Age, sex and initial systolic blood pressure strongly influence response to carotid sinus massage. Abnormal responses did not correlate with positive tilt test results, possibly as a result of opposing effects of age and sex on carotid sinus hypersensitivity and vasovagal syncope.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"499-511"},"PeriodicalIF":4.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148155210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthostatic hypotension and complaints: not a clear-cut relation.","authors":"Boriana S Gagaouzova, Ineke A van Rossum, Fabian I Kerkhof, Roland D Thijs, J Gert van Dijk","doi":"10.1007/s10286-026-01222-3","DOIUrl":"10.1007/s10286-026-01222-3","url":null,"abstract":"<p><strong>Purpose: </strong>Previous research regarding the association between blood pressure (BP) fall and symptoms yielded inconsistent results in classical orthostatic hypotension (cOH), with some studies proposing specific cut-off values and others reporting only weak or absent correlations. This study examined clinical cOH symptoms in relation to changes in BP and the haemodynamic parameters determining BP.</p><p><strong>Methods: </strong>We retrospectively analysed 77 tilt test records showing cOH and selected 40 with and 37 without complaint recognition during the test. We compared absolute values of haemodynamic parameters as well as the differences and ratios compared to supine baseline at three different times during tilt. We also explored relationships between relative haemodynamic changes and symptoms with the log-ratio method.</p><p><strong>Results: </strong>There was a larger blood pressure fall in the group with complaint recognition compared (49.2 vs 37.3, p = 0.043). The log-ratio analysis showed less total peripheral resistance increase and a larger blood pressure decrease in the symptomatic group.</p><p><strong>Conclusion: </strong>Recognised complaints were related to a larger BP fall, while in previous studies complaints were either not related to BP or to minimum BP. These contrasts suggest that the pathophysiology of orthostatic complaints is complex. The chain of events from low BP to awareness of complaints contains multiple links, of which cerebral perfusion is probably a critical one. We suggest that the pathway contains so much variability that we should not expect the relation between low blood pressure and complaints in cOH to be simple.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"467-475"},"PeriodicalIF":4.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reproducibility of orthostatic blood pressure measurements in a middle-aged population-based cohort: a one-year follow-up study.","authors":"Christian Zambach, Sofia Gerward, Steven van Zanten, Frederik J de Lange, Artur Fedorowski, Gunnar Engström, Viktor Hamrefors","doi":"10.1007/s10286-026-01205-4","DOIUrl":"10.1007/s10286-026-01205-4","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"541-544"},"PeriodicalIF":4.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adrenocortical response during HUT test in patients with vasovagal syncope.","authors":"Barbora Pavlovič Bačkorová, Zora Lazúrová, Monika Lukáčová, Kristína Valová, Peter Mitro, Ivica Lazúrová","doi":"10.1007/s10286-026-01203-6","DOIUrl":"10.1007/s10286-026-01203-6","url":null,"abstract":"<p><strong>Purpose: </strong>This prospective observational study was carried out to evaluate the response of adrenocortical hormones (cortisol and aldosterone) to head-up tilt (HUT)-induced vasovagal syncope in relation to hemodynamic changes.</p><p><strong>Subjects and methods: </strong>Blood samples from 79 patients (48 women and 31 men, age 19-73 years) who underwent the HUT test were analyzed for serum aldosterone and cortisol. On the basis of their response, patients were categorized into two groups: 50 HUT-positive (HUT+) and 29 HUT-negative (HUT-) patients.</p><p><strong>Results: </strong>HUT+ patients exhibited significantly lower baseline aldosterone levels compared with HUT- patients (203.1 ± 78.8 versus 266.2 ± 76.3 pg/ml, p = 0.0009). Similarly, aldosterone levels after the HUT test were lower in the HUT+ as compared with the HUT- group (249.5 ± 101.3 versus 351.4 ± 98.11 pg/ml, p < 0.0001). However, serum cortisol showed no significant differences between groups. Aldosterone increased in response to HUT in both groups. Aldosterone positively correlated with systolic and diastolic blood pressure, as well as heart rate. Integration of aldosterone with clinical assessment and additional laboratory tests may improve diagnostic accuracy and risk stratification.</p><p><strong>Conclusions: </strong>The results demonstrate significantly lower serum aldosterone concentrations in HUT+ patients at baseline and after HUT test in comparison with HUT- patients. Moreover, aldosterone levels positively correlated with systolic and diastolic blood pressure (BP). However, serum cortisol levels did not discriminate HUT+ from HUT- patients.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"477-484"},"PeriodicalIF":4.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147479901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of hyperadrenergic orthostatic hypotension.","authors":"Robert A Castro, Pouya E Mehr, Patricio Millar Vernetti, Naome Mwesigwa, Italo Biaggioni, Satish R Raj, Esraa Shehata, Amber J Hackstadt, Tan Ding, Horacio Kaufmann, Cyndya A Shibao","doi":"10.1007/s10286-026-01211-6","DOIUrl":"10.1007/s10286-026-01211-6","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"545-548"},"PeriodicalIF":4.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147947840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular pharmacology of dopaminergic agents in humans: a review.","authors":"Jose-Alberto Palma, Jose G Gomez Casanovas","doi":"10.1007/s10286-026-01229-w","DOIUrl":"10.1007/s10286-026-01229-w","url":null,"abstract":"<p><strong>Purpose: </strong>To review the cardiovascular effects of pharmacologic dopamine receptor modulation in humans, organized by receptor subtype.</p><p><strong>Methods: </strong>Narrative review of human pharmacological, genetic, and clinical evidence linking dopamine receptor agonism and antagonism to blood pressure and heart rate changes in healthy volunteers and in patients with Parkinson disease, autonomic failure, psychiatric disorders, and selected cardiovascular conditions.</p><p><strong>Results: </strong>Dopaminergic receptor agonism generally lowers blood pressure, with the magnitude of hypotension tracking with intrinsic activity: full orthosteric agonists (bromocriptine, ropirinole, apomorphine) carry the highest risk of orthostatic hypotension, and partial agonists (tavapadon) produce attenuated but clinically relevant hypotension. Dopamine D3-preferring agents (PF-592379, mesdopetam, cariprazine) have neutral cardiovascular effects in short-term trials. Levodopa-induced orthostatic hypotension arises from at least five converging mechanisms whose clinical impact is amplified by underlying neurogenic orthostatic hypotension. A notable exception is mevidalen, a centrally acting dopamine D1 positive allosteric modulator that paradoxically raises blood pressure. Despite murine knockout models consistently predicting that dopamine receptor deletion produces hypertension, pharmacological antagonism in humans does not reliably raise blood pressure: dopamine D1, D2, and D3 antagonists show largely neutral cardiovascular profiles, while antipsychotic-associated orthostatic hypotension is driven primarily by α1-adrenergic blockade.</p><p><strong>Conclusions: </strong>The cardiovascular response to dopaminergic agents depends on receptor selectivity, intrinsic activity, and baroreflex integrity. The discrepancy between murine-knockout-predicted hypertension and human pharmacological neutrality with antagonists, and the hypertensive effects of dopamine D1 positive allosteric modulators, represent key unresolved questions.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"427-443"},"PeriodicalIF":4.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sigmoid volvulus, acute colonic pseudo-obstruction, and chronic megacolon in Parkinson disease.","authors":"John A Damianos, Kara J Jencks, Wolfgang Singer, Kristina Matkowskyj, Robert R Cima, Michael Camilleri","doi":"10.1007/s10286-026-01219-y","DOIUrl":"10.1007/s10286-026-01219-y","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"525-529"},"PeriodicalIF":4.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147980724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}