Clinical Autonomic Research最新文献

{"title":"Locus coeruleus degeneration is associated with orthostatic hypotension in Parkinson's disease and multiple system atrophy.","authors":"Paul A Beach, Sierra Hyland, Xiangchuan Chen, Daniel E Huddleston","doi":"10.1007/s10286-025-01164-2","DOIUrl":"10.1007/s10286-025-01164-2","url":null,"abstract":"<p><strong>Purpose: </strong>We compared locus coeruleus (LC) structural integrity, as measured by neuromelanin-sensitive magnetic resonance imaging (NM-MRI), between patients with Parkinson's disease (PD) and those with multiple system atrophy (MSA) and tested whether orthostatic hypotension (OH) impacted differences in LC volume between PD and MSA. Substantia nigra (SNc) volumes were compared between these groups to determine whether effects observed in LC were specific to that structure. Last, we tested whether LC integrity is associated with orthostatic hemodynamic responses.</p><p><strong>Methods: </strong>Presence or absence of (±)OH was determined with active stand testing. Automated segmentation of LC and SNc volumes took place using NM-MRI. Structural volumes were first compared between PD and MSA groups and, second, after stratification by OH status. Last, correlations between LC volumes and orthostatic vitals were calculated.</p><p><strong>Results: </strong>Of 71 patients with PD, 19 were (+)OH. Of 19 patients with MSA, 12 were (+)OH. LC volumes were larger in PD than MSA (p = 0.002), and LC volumes in PD(-)OH were larger than PD(+)OH and MSA(±)OH (p < 0.05). All comparisons involving SNc were nonsignificant. Primarily in PD(-)OH, LC volumes correlated negatively with supine mean arterial pressure (MAP) and positively with supine heart rate. In PD(+OH) and MSA(+)OH, lower LC volumes were correlated with greater orthostatic falls in MAP.</p><p><strong>Conclusions: </strong>Similar levels of LC neurodegeneration were observed in PD(+)OH and MSA(±)OH. Therefore, LC measurement may be useful to differentiate PD(-)OH from MSA. Lower LC volumes additionally correlated with greater drops in MAP in both PD(+)OH and MSA(+)OH, suggesting that LC neurodegeneration may contribute to OH in both conditions.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"53-64"},"PeriodicalIF":4.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12982258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421361","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":"Orthostatic cerebral hypoperfusion syndrome: an uncommon cause of orthostatic intolerance in a patient with COVID-19.","authors":"Jie Zhang, Yao Wang, Lijuan Wang","doi":"10.1007/s10286-025-01162-4","DOIUrl":"10.1007/s10286-025-01162-4","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"131-135"},"PeriodicalIF":4.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184656","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":"Letter to the editor regarding \"Chronic autonomic symptom burden in long-COVID: a follow-up cohort study.\"","authors":"Sean Zadeh, Nathaniel Robbins, Roberto Hernandez, Meredith Bryarly, Steven Vernino","doi":"10.1007/s10286-025-01161-5","DOIUrl":"10.1007/s10286-025-01161-5","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"145-146"},"PeriodicalIF":4.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231557","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":"Response to letter by Zadeh et al. regarding \"Chronic autonomic symptom burden in long-COVID: a follow-up cohort study\".","authors":"Lauren E Stiles, Nicholas W Larsen, Ella F Eastin, Mitchell G Miglis","doi":"10.1007/s10286-025-01174-0","DOIUrl":"10.1007/s10286-025-01174-0","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"147-149"},"PeriodicalIF":4.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548375","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":"Exploring the relationship between orthostatic hypotension and gait in people with Parkinson's disease.","authors":"Tuhin Virmani, Rebecca D Jones, Lakshmi Pillai","doi":"10.1007/s10286-025-01149-1","DOIUrl":"10.1007/s10286-025-01149-1","url":null,"abstract":"<p><strong>Purpose: </strong>Orthostatic hypotension (OH) is a non-motor feature in people with Parkinson's disease that can lead to falls from syncope. Current knowledge is lacking on the effects of OH on gait function.</p><p><strong>Methods: </strong>Participants enrolled in a prospectively monitored longitudinal cohort who had OH on vitals at one of two consecutive visits approximately 6 months apart were analyzed. Gait measures were compared at the orthostatic versus non-orthostatic visit using the Wilcoxon signed-rank test and a linear mixed model. Motor and non-motor assessments were also compared.</p><p><strong>Results: </strong>Thirty-nine people with Parkinson's disease and seven age-matched controls in the longitudinal study met the inclusion criteria. Mean stride length and foot-strike length were shorter, and stride velocity was slower at the orthostatic visit compared to the non-orthostatic visit in people with Parkinson's disease. Levodopa dose, duration from last dose, motor and total Unified Parkinson's Disease Rating Scale scores, and cognitive and non-motor assessment scores did not differ between visits. The number of people reporting falls was higher at the orthostatic visit, and the fall frequency in fallers also trended higher. Gait measures did not differ between those with and without symptomatic OH.</p><p><strong>Conclusion: </strong>In our cohort of people with Parkinson's disease with repeated measures, gait was more parkinsonian (slower velocity, shorter stride, and decreased foot strike to the ground) when they had OH on vitals at the visit than when they did not. Based on our results, future studies exploring the impact of adequate treatment of OH on gait function are warranted.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"817-828"},"PeriodicalIF":4.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13494895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005974","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":"Orthostatic hypotension in Parkinson's disease-More than just lightheadedness and fainting.","authors":"Guillaume Lamotte","doi":"10.1007/s10286-025-01155-3","DOIUrl":"10.1007/s10286-025-01155-3","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"861-862"},"PeriodicalIF":4.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014011","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":"Screening for acute hepatic porphyria in postural tachycardia syndrome.","authors":"Naome Mwesigwa, Hadley Williamson, Shalonda Turner, Mehr E Pouya, Tan Ding, Ortiz J Pedro, Karl E Anderson, Cyndya A Shibao","doi":"10.1007/s10286-025-01153-5","DOIUrl":"10.1007/s10286-025-01153-5","url":null,"abstract":"<p><strong>Purpose: </strong>Postural orthostatic tachycardia syndrome (POTS) is characterized by an excessive heart rate increase upon standing, often associated with dizziness, gastrointestinal symptoms, and decreased functional capacity. Acute hepatic porphyrias (AHP) are rare metabolic disorders with nonspecific neurovisceral and autonomic symptoms, some of which overlap with POTS. The purpose of this study was to evaluate AHP by molecular and biochemical testing in patients with POTS.</p><p><strong>Methods: </strong>We studied 50 patients diagnosed with POTS and gastrointestinal symptoms at the Vanderbilt Autonomic Dysfunction Center. They underwent neuro-hormonal evaluation for POTS and genetic and biochemical screening for AHP. Genetic testing was aimed mainly at the four genes relevant to AHPs. Porphobilinogen (PBG), delta-aminolevulinic acid (ALA), and total porphyrins were measured in urine with normalization to creatinine.</p><p><strong>Results: </strong>The average age of the patients was 33 ± 8.6 years, 96% were female, and the average BMI was 28 ± 7.2 kg/m², average systolic blood pressure was 120 ± 15.5 mmHg, average heart rate was 77 ± 13.6 bpm at baseline, and average SBP was 126 ± 19.1 mmHg. A heart rate of 111 ± 15.8 bpm at 10 min upright, showed normal cardiovascular reflexes. The COMPASS-31 total score was 32 ± 8.4, with a normal autonomic function test. Urine PBG averaged 1 ± 0.7 mg/g creatinine, ALA 2 ± 0.9 mg/g creatinine, and total porphyrins 172 ± 74.2 mmol/g creatinine, which were all normal. None had variants in the four genes associated with AHPs. Three patients were heterozygous for a common low expression ferrochelatase gene variant (FECH).</p><p><strong>Conclusions: </strong>We found no evidence of AHP in patients with POTS with uncontrolled gastrointestinal symptoms, suggesting that screening for AHP, a rare genetic disorder, may not be warranted.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"847-851"},"PeriodicalIF":3.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12664853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945012","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":"Diagnostic yield of nitroglycerin-potentiated head-up tilt test in a pediatric population with suspected reflex syncope.","authors":"Vincenzo Russo, Angelo Comune, Giangiacomo Di Nardo, Erika Parente, Giovanni Maria Di Marco, Angelica De Nigris, Maria Giovanna Russo, Berardo Sarubbi, Gerardo Nigro, Michele Brignole","doi":"10.1007/s10286-025-01145-5","DOIUrl":"10.1007/s10286-025-01145-5","url":null,"abstract":"<p><strong>Background: </strong>Syncope is a prevalent issue in pediatric patients. The nitroglycerin (NTG)-potentiated head-up tilt test (HUTT) is widely used in adults for diagnosing reflex syncope; however, few and contrasting data are available in pediatric populations. The aim of our study was to evaluate the positivity rate and types of responses to NTG-potentiated HUTT in pediatric patients with suspected reflex syncope.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter analysis of 307 pediatric patients (mean age: 14.4 ± 2.8 years; 57.6% female) who underwent HUTT at two syncope units in Naples, Italy. A group of 16 healthy pediatric subjects (13 ± 3.2 years; 37.5% female) with no history of syncope was used as a control. We described the HUTT overall positivity rate and responses; moreover, the positivity rate, sensitivity, and specificity were evaluated. A multivariate analysis was performed to test the association of positive response to HUTT with a set of clinical covariates.</p><p><strong>Results: </strong>The overall HUTT positivity rate was 74.9%, ranging from 51.5% to 81.6% among pediatric patients with non-classical and classical presentation, respectively. The HUTT positivity rate among healthy control group was 18.7%; consequently the HUTT specificity was 81.3%. Younger age (OR: 0.84; p = 0.005) and female sex (OR: 2.3; p = 0.005) were independent predictors of HUTT positivity; in contrast, the non-classical presentation of syncope (OR: 0.23; p < 0.001) and situational syncope (OR: 0.2; p = 0.006) correlated negatively with HUTT positivity.</p><p><strong>Conclusions: </strong>NTG-potentiated HUTT showed a high positivity rate, good sensitivity, and specificity in pediatric patients with suspected reflex syncope. Some patients and syncope-related features independently correlated with HUTT positivity. Cardioinhibitory response was more prevalent in pediatric patients with a non-classical presentation of reflex syncope.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"799-805"},"PeriodicalIF":3.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12664829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783628","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":"Blunted baroreflex-mediated sympathoinhibition and vasodilation to countdown before exercise in young women compared to men.","authors":"Kazumasa Manabe, Andrew W D'Souza, Ryosuke Takeda, Sarah L Hissen, Takuro Washio, John D Akins, Belinda Sanchez, Qi Fu","doi":"10.1007/s10286-025-01132-w","DOIUrl":"10.1007/s10286-025-01132-w","url":null,"abstract":"<p><strong>Purpose: </strong>In our previous study (Manabe et al., J Appl Physiol 128:1196-1206, 1985), we demonstrated that the cerebral and cardiovascular responses induced by a pre-exercise countdown elicited peripheral vasodilation via baroreflex-mediated sympathetic withdrawal, which is likely advantageous for rapid oxygen delivery to contracting skeletal muscles in young men. Whether this is also true in young women, who generally show different neuro-cardiovascular responses to stress compared to men, remains unknown. Thus, we examined whether biological sex would affect the neuro-cardiovascular responses to anticipation before exercise.</p><p><strong>Methods: </strong>Young healthy women (n = 11) and men (n = 10) performed 1 min of static handgrip at 30% of maximal voluntary contraction force twice; once with a 30 sec countdown and once after being immediately signaled to begin exercise (without countdown), with the order randomized. Middle cerebral artery blood velocity (V_MCA; transcranial Doppler), heart rate (HR), cardiac index [CI; HR × stroke volume (Modelflow)/body surface area], mean arterial pressure (MAP; finger photoplethysmography), muscle sympathetic nerve activity (MSNA; microneurography), and leg vascular conductance [LVC = superficial femoral artery blood flow (ultrasound)/MAP] were measured continuously.</p><p><strong>Results: </strong>During countdown, women exhibited smaller increases in CI, MAP, and LVC and a smaller decrease in MSNA than men (p < 0.05). Increases in V_MCA and HR, and the sympathetic baroreflex sensitivity did not differ between sexes (p > 0.05).</p><p><strong>Conclusion: </strong>Young women seem to have less baroreflex-mediated sympathetic withdrawal and peripheral vasodilatory responses to the countdown compared to young men, despite similar cerebral vascular responses. These findings may suggest women have reduced neuro-vascular responses to exercise anticipation, which could impact the ability of oxygen delivery at exercise onset.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"747-757"},"PeriodicalIF":4.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086006","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":"Prediction evaluation of the Tp-Te interval in patients with vasovagal syncope.","authors":"Xiaomin Zhang, Shuting Dai, Haitao Wang, Ruirui Jiang, Qian Xie, Jing Wen, Min Han, Yi Xu, Gang Wang","doi":"10.1007/s10286-025-01148-2","DOIUrl":"10.1007/s10286-025-01148-2","url":null,"abstract":"<p><strong>Purpose: </strong>Vasovagal syncope (VVS) involves autonomic dysregulation affecting cardiac electrical activity. The Tp-Te interval, reflecting transmural repolarization dispersion, may help predict positive head-up tilt test (HUTT) responses in patients with suspected VVS.</p><p><strong>Methods: </strong>A total of 179 patients with suspected VVS were included in the study. A HUTT was performed in enrolled patients, which were divided into HUTT-negative and HUTT-positive groups, and the HUTT-positive group was further classified into three subgroups of \"vasodepressor,\" \"cardioinhibitory,\" and \"mixed-type\" responses to HUTT. QT interval, corrected QT (QTc) interval, and Tp-Te interval were measured by the baseline 12-lead surface electrocardiograph recorded before HUTT.</p><p><strong>Results: </strong>The QT interval, QTc interval, and Tp-Te interval in the HUTT-positive group were higher than those in the HUTT-negative group (P < 0.001). Tp-Te was higher in the cardioinhibitory and mixed-type subgroups than in the vasodepressor subgroup (P < 0.05). Receiver operating characteristic curve analysis showed that Tp-Te higher than 88 ms was a significant predictor of positive HUTT results (71.70% sensitivity and 75.90% specificity), with a predictive value significantly higher than QT and QTc (P < 0.05), and Tp-Te higher than 95 ms predicted cardioinhibitory and mixed-type response to HUTT (75% sensitivity, and 57.10% specificity).</p><p><strong>Conclusion: </strong>Baseline myocardial TDR is associated with VVS and susceptibility to VVS. The baseline Tp-Te interval might be used as a novel noninvasive index for differentiating cardioinhibitory, mixed-type, and vasodepressor responses to HUTT and for predicting the occurrence of cardioinhibitory responses in VVS patients.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"791-798"},"PeriodicalIF":4.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945021","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}