Clinical Autonomic Research最新文献

{"title":"Acute effects of binge drinking following aerobic exercise on autonomic and hemodynamic recovery in young men: a randomized crossover trial.","authors":"Yun Wook Kim, Chang Jin Han, Tae Gu Choi, Byul Kim, Hyun Jeong Kim, Sae Young Jae","doi":"10.1007/s10286-026-01243-y","DOIUrl":"https://doi.org/10.1007/s10286-026-01243-y","url":null,"abstract":"<p><strong>Purpose: </strong>Impaired autonomic and hemodynamic recovery after acute aerobic exercise is linked to greater susceptibility to sudden cardiovascular events. Binge drinking can increase cardiovascular risk, partly through elevations in heart rate, blood pressure, and sympathetic activity, yet alcohol is commonly consumed after exercise. We tested whether binge drinking after acute aerobic exercise delays autonomic and hemodynamic recovery in young men.</p><p><strong>Methods: </strong>In a randomized crossover design, 14 young men (mean age 25 years; body mass index 25.1 kg/m²) completed a 30-min treadmill run at 55-60% of heart rate reserve, followed immediately by water (360 mL) or alcohol (soju; 360 mL containing 60 g ethanol). Autonomic function was assessed using heart rate variability (HRV); hemodynamics included heart rate, brachial blood pressure, and rate-pressure product (RPP). Measurements were obtained at baseline and at 1 h and 2 h postexercise.</p><p><strong>Results: </strong>Breath alcohol concentration increased after alcohol ingestion at 1 h (0.08 ± 0.02) and 2 h (0.06 ± 0.02) postexercise (condition × time, p < 0.001). Compared with water, postexercise alcohol delayed autonomic recovery, with persistently reduced HRV and a sustained shift toward sympathetic predominance (higher SNS index, lower PNS index; condition × time, all p ≤ 0.002). Heart rate and rate-pressure product also remained elevated during recovery in the alcohol condition.</p><p><strong>Conclusions: </strong>Binge drinking after aerobic exercise delays autonomic recovery and increases myocardial oxygen demand in young men, supporting avoidance of alcohol during the early postexercise period.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073676","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":"ANTHEM-HFrEF: does early termination obscure a potential treatment signal?","authors":"Stefanos Zafeiropoulos, Stavros Stavrakis","doi":"10.1007/s10286-026-01240-1","DOIUrl":"https://doi.org/10.1007/s10286-026-01240-1","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029582","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":"Baseline peripheral inflammatory profiles predict phenoconversion in prodromal Parkinson's disease: a longitudinal cohort study.","authors":"Zhiqi Jia, Tianjiao Zhang, Garry Wong","doi":"10.1007/s10286-026-01245-w","DOIUrl":"https://doi.org/10.1007/s10286-026-01245-w","url":null,"abstract":"<p><strong>Purpose: </strong>Autonomic dysfunction is an early and prognostically important feature of Parkinson's disease, yet accessible biomarkers capturing systemic inflammatory processes potentially linked to autonomic dysfunction during the prodromal phase remain limited. We evaluated whether complete blood count-derived inflammatory indices predict phenoconversion in prodromal Parkinson's disease.</p><p><strong>Methods: </strong>We conducted a retrospective cohort analysis of 452 prodromal participants from the Parkinson's Progression Markers Initiative. Five complete blood count-derived inflammatory indices-the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, and systemic inflammation response index-were evaluated using Cox proportional hazards models with penalized variable selection, sex-stratified analyses, and internal validation.</p><p><strong>Results: </strong>During follow-up, 43 participants (9.5%) phenoconverted. The systemic inflammation response index showed the strongest and most consistent association with phenoconversion, remaining independently associated after penalized variable selection (hazard ratio 2.34 per log-unit, 95% confidence interval 1.28-4.29; optimism-corrected concordance statistic 0.683; calibration slope 0.864). Effect estimates were larger in male participants, while female estimates were imprecise as a result of limited events; no statistically significant biomarker-by-sex interaction was detected. Longitudinal analyses indicated that baseline inflammatory levels, rather than subsequent changes, carried the primary prognostic signal.</p><p><strong>Conclusion: </strong>Baseline systemic inflammation response index derived from routine complete blood counts was associated with phenoconversion risk in prodromal Parkinson's disease, although with a relatively low number of phenoconversion events. External validation of these findings with larger, independent cohorts would further support its utility in peripheral systemic inflammatory conditions such as those observed in autonomic dysfunctions.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029693","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":"Correlation of utricular function with elevated ambulatory heart rate in postural orthostatic tachycardia syndrome.","authors":"Yukang Kim, Tonghoon Woo, Jueun Kim, Jin-Woo Park, Sun-Uk Lee, Euyhyun Park, Gerard J Kim, Byung-Jo Kim, Ji-Soo Kim","doi":"10.1007/s10286-026-01236-x","DOIUrl":"https://doi.org/10.1007/s10286-026-01236-x","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015865","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":"The hidden burden: connective tissue, mast cell, and autoimmune comorbidities cluster in POTS with endometriosis.","authors":"Adeline Y Chin, Ryan G Rilinger, Phoebe Leboit, Mackaleigh Levine, Amy S Nowacki, Ashley R Brant, Cheryl Cameron, Ashley Gubbels, Robert Wilson","doi":"10.1007/s10286-026-01244-x","DOIUrl":"https://doi.org/10.1007/s10286-026-01244-x","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015906","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":"Utility and best practices for clinical diagnostic testing of the autonomic nervous system: A Consensus Statement Endorsed by the American Autonomic Society and the American Association of Neuromuscular & Electrodiagnostic Medicine.","authors":"Melissa M Cortez, Glen Cook, Mitchell G Miglis, Satish R Raj, Nathaniel M Robbins, Wolfgang Singer, David M Sletten, Amro M Stino, Steven Vernino","doi":"10.1007/s10286-026-01238-9","DOIUrl":"https://doi.org/10.1007/s10286-026-01238-9","url":null,"abstract":"<p><strong>Purpose: </strong>Disorders of the autonomic nervous system are prevalent and associated with substantial morbidity, mortality and diagnostic delay. Standardized, laboratory-based autonomic function testing provides objective physiological data essential for diagnosing, staging, and monitoring autonomic disorders, yet no current consensus statement establishes best practices for the conduct, interpretation, and minimum quality standards of such testing.</p><p><strong>Methods: </strong>The American Autonomic Society convened a writing committee of autonomic specialists to review published evidence and established practices governing standardized autonomic reflex function testing in clinical settings. This consensus statement builds upon prior position statements published by North American and European professional societies.</p><p><strong>Results: </strong>We summarize the clinical evidence supporting standardized autonomic reflex function testing across a broad range of conditions, including neurodegenerative disorders, peripheral neuropathies, orthostatic intolerance syndromes, and autoimmune autonomic disorders. We describe the validated battery of tests -orthostatic challenge, Valsalva maneuver, cardiovagal heart rate variability testing, and sudomotor testing-with attention to physiological principles, technical standards, and clinical interpretation. Minimum standards are defined for the requisite roles in autonomic testing: the autonomic technician, supervising clinician, and interpreting autonomic physician. Special considerations for pediatric, pregnant, and critically ill populations are addressed, and emerging adjunctive techniques are reviewed.</p><p><strong>Conclusion: </strong>Standardized autonomic reflex function testing is clinically useful, well validated, evidence-based, and non-investigational when performed by qualified personnel adhering to best practices. Autonomic testing is irreplaceable for clinical decision-making in certain circumstances and should be integrated into clinical practice when appropriate.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015848","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":"Hyperadrenergic and neuropathic features based on clinical autonomic testing in individuals with POTS: an observational cross-sectional study.","authors":"Jonathan Trout, Guillaume Lamotte, Jordan Langford, Luke Heyliger, Melissa M Cortez","doi":"10.1007/s10286-026-01239-8","DOIUrl":"https://doi.org/10.1007/s10286-026-01239-8","url":null,"abstract":"<p><strong>Purpose: </strong>Hyperadrenergic and neuropathic features have been described in postural tachycardia syndrome (POTS). This study describes the prevalence, autonomic testing characteristics, and symptom severity of individuals with hyperadrenergic and neuropathic features in a laboratory-diagnosed POTS cohort.</p><p><strong>Methods: </strong>We performed a cross-sectional study of individuals with a laboratory diagnosis of POTS. Hyperadrenergic POTS (HyperPOTS) features were defined as an upright norepinephrine level of > 600 pg/mL and/or > 3 times their respective supine norepinephrine. Neuropathic POTS (NeuroPOTS) features were defined by a CASS ≥ 2 and/or ≥ 1 sudomotor abnormalities. Autonomic symptom severity was determined by the Composite Autonomic Symptom Score (COMPASS-31). Other standard autonomic reflex testing components, including heart rate response to deep breathing (HRDB), Valsalva, and 10-min head-up tilt testing, were also performed.</p><p><strong>Results: </strong>Of the 223 participants (mean age 31.6 years; female 89%), 161 (41%) had HyperPOTS features, 113 (29%) exhibited NeuroPOTS features, and 40 (18%)/48 (22%) demonstrated neither or both, respectively. NeuroPOTS features were associated with higher supine HR and rates of abnormal HRDB than those without NeuroPOTS. No significant differences in COMPASS-31 scores were found between all groups studied.</p><p><strong>Conclusion: </strong>HyperPOTS and NeuroPOTS are common, co-occurring features in adults with POTS. Autonomic symptom burden did not differ significantly between phenotypes, likely reflecting insensitivity of the COMPASS-31 to phenotype-specific domains. NeuroPOTS was associated with impaired cardiovagal function, consistent with involvement in cardiac postganglionic parasympathetic pathways, though this is partly confounded by HRDB's inclusion in our NeuroPOTS definition. These findings support the concept that POTS phenotyping may aid in therapy selection, and the need for phenotype-sensitive symptom instruments.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001369","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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584761/pdf/","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":"OA","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}