Clinical Autonomic Research最新文献

{"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":"https://doi.org/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":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-03","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}

{"title":"Progressive baroreflex dysfunction and hypotension preceding VVS: a vicious cycle?","authors":"D L Jardine, V Stott, C Frampton","doi":"10.1007/s10286-025-01147-3","DOIUrl":"https://doi.org/10.1007/s10286-025-01147-3","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to clarify the mechanism for presyncope, defined as the gradual onset of hypotension, starting some minutes before vasovagal syncope. Although there is a fall in cardiac output and usually vasodilatation, the control of sympathetic activity during presyncope is uncertain.</p><p><strong>Methods: </strong>We retrospectively compared haemodynamics and muscle sympathetic nerve activity levels from positive tilt tests (without provocation) in patients with known vasovagal syncope (age 41 ± 3 years, 13 female, n = 27) to controls (age 39 ± 3 years, 8 female, n = 13). We used sequence methods to measure vascular sympathetic and cardiovagal baroreflex gain at baseline (lying supine) during tilt, presyncope and recovery.</p><p><strong>Results: </strong>Patients were tilted for 18.1 ± 1 min, and mean arterial pressure fell to 62 ± 3 mmHg before tilt-back. At baseline and early tilt, all haemodynamic variables were similar to controls, however sympathetic baroreflex gain was increased: -2.7 ± 0.2 bursts/100 beats/mmHg versus -2.0 ± 0.3 (p = 0.03). Cardiovagal baroreflex gain was increased at baseline 11.8 ± 0.6 ms/mmHg versus 9.3 ± 0.8 (p = 0.02). During early presyncope (from 8 to 4 min before tilt-back), sympathetic baroreflex gain fell to -2.4 bursts/100 b/mmHg and thereafter to -0.5 ± 0.3 (p = 0.01) during late presyncope, before losing correlation with mean arterial pressure. In some patients, the regression coefficient reversed before correlation was lost (n = 8) but this did not result in lower levels of nerve activity. At tilt-back, nerve activity fell below baseline levels in at least 63% of patients.</p><p><strong>Conclusion: </strong>Presyncope appeared to be initiated by a fall in sympathetic baroreflex gain despite increased levels at baseline and early tilt.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945019","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":"https://doi.org/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":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","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":"https://doi.org/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":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Body-first\" dementia with Lewy bodies.","authors":"David S Goldstein, Courtney Holmes, Patti Sullivan, Risa Isonaka, Dragan Maric, Parvez Alam, Christine Cliatt-Brown, Janna Gelsomino, Sarah Moore, Byron Caughey, Guillaume Lamotte","doi":"10.1007/s10286-025-01128-6","DOIUrl":"10.1007/s10286-025-01128-6","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"623-627"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978393","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 clinical characteristics and response to head-up tilt test of patients with micturition syncope: single-center experience in China.","authors":"Jing Li, Xuan Xiao, Shunzhi He, Haitao Sun","doi":"10.1007/s10286-025-01126-8","DOIUrl":"10.1007/s10286-025-01126-8","url":null,"abstract":"<p><strong>Objective: </strong>This study compared clinical characteristics and response to head-up tilt test (HUTT) between micturition syncope (MS) and typical vasovagal syncope (VVS).</p><p><strong>Methods: </strong>Consecutive patients who underwent nitroglycerin-potentiated HUTT were retrospectively dichotomized into two groups: those with a history of MS and those with a history of VVS. The patients with MS were further subdivided into patients with MS alone and with MS and at least one episode of VVS.</p><p><strong>Results: </strong>A total of 2637 patients were enrolled: 204 had MS (MS alone in 103 and MS+VVS in 101), and 216 had typical VVS. Patients with MS were older (38.6 ± 13.1 vs. 36.3 ± 18.5, p = 0003) and more likely to be male (66.2% vs. 48.1%, p < 0.001). Multivariable analysis revealed that smoking habit (odds ratio [OR] 2.16, p < 0.0001), history of traumatic syncope (OR 2.24, p = 0.0001), and drinking alcohol before syncope (OR 2.63, p < 0.0001) were independently associated with MS. HUTT was positive in 141 (69.1%) patients with MS and in 144 (66.7%) patients with VVS (p = 0.592). Patients with MS showed more mixed (46.1% vs. 28.2%, p < 0.001) and vasodepressor forms (15.2% vs. 7.9%, p = 0.013) and fewer cardioinhibitory responses than others (7.4% vs. 30.6%, p < 0.001).</p><p><strong>Conclusions: </strong>Compared with VVS, patients with MS have different clinical characteristics, and drinking alcohol was an important precipitating factor for MS. The positivity rate of HUTT is high and similar to that of VVS, although patients with MS show a higher prevalence of hypotensive responses.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"617-622"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975167","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":"Neurological perspectives and gastroenterological motility diseases: ten lessons from clinical practice.","authors":"Michael Camilleri","doi":"10.1007/s10286-025-01137-5","DOIUrl":"10.1007/s10286-025-01137-5","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"601-606"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132134","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":"Characterising Postural Orthostatic Tachycardia Syndrome (POTS) triggered by a viral illness compared to concussion or trauma.","authors":"Gemma Wilson, Marie-Claire Seeley, Pauline Slater, Dennis H Lau, Celine Gallagher","doi":"10.1007/s10286-025-01136-6","DOIUrl":"10.1007/s10286-025-01136-6","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"637-641"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339959","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":"Accuracy of chat-based artificial intelligence for patient education on orthostatic hypotension.","authors":"W P Cheshire, P Sandroni, K Shouman, J K Cutsforth-Gregory, E A Coon, E E Benarroch, W Singer, P A Low","doi":"10.1007/s10286-025-01125-9","DOIUrl":"10.1007/s10286-025-01125-9","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"633-636"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751239","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":"Peripheral autonomic failure is associated with more severe postprandial hypotension compared to central autonomic failure.","authors":"Pouya E Mehr, Pedro J Ortiz, Kaitlyn R O'Rourke, Tan Ding, Amber J Hackstadt, Surat Kulapatana, André Diedrich, Daniel O Claassen, Italo Biaggioni, Amanda C Peltier, Cyndya A Shibao","doi":"10.1007/s10286-025-01131-x","DOIUrl":"10.1007/s10286-025-01131-x","url":null,"abstract":"<p><strong>Purpose: </strong>Postprandial hypotension (PPH) defined as a decrease in systolic blood pressure of more than 20 mmHg within 2 h post meal is prevalent in patients with autonomic failure and is associated with negative cardiovascular outcomes. Previous studies reported peripheral autonomic failure with less residual sympathetic tone in Parkinson disease (PD). Therefore, we hypothesized that PPH is more severe in PD than in multiple system atrophy (MSA) with central autonomic failure.</p><p><strong>Methods: </strong>Thirteen patients with PD and 13 patients with MSA were enrolled. Autonomic function testing and neurohormonal measurements were performed to assess autonomic failure and residual sympathetic activity. Subjects were fed a standard breakfast. Systolic and diastolic blood pressure and heart rate were monitored every 5 min from 30 min before to 120 min post meal. Postprandial hemodynamic changes were summarized using area under the curve (AUC). Differences between the groups were assessed with two-sample independent t test and linear regression.</p><p><strong>Results: </strong>Patients with PD (69% male, 72 ± 9 years) had a significantly lower post-meal diastolic blood pressure (P = 0.003) and heart rate AUC (P = 0.007) than patients with MSA (62% male, 62 ± 8 years). After adjusting for age and supine systolic blood pressure, PD as diagnosis still had significant estimate effect for diastolic blood pressure AUC (P = 0.019). No significant difference was found in the mean systolic blood pressure AUC, but at 30 min post meal, systolic blood pressure decrease was significantly lower in PD (P = 0.016).</p><p><strong>Conclusion: </strong>The PD group with peripheral autonomic failure exhibits more severe PPH than the MSA group. This highlights the need for tailored management for PPH in PD.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"607-616"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12325557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969646","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}