Clinical Autonomic Research最新文献

{"title":"Elevated blood pressure variability links cardiac autonomic dysfunction to complex arrhythmias in hypertension.","authors":"Yang You, Xiaoyan Han, Guoqing Qi, Jun Liu, Li Tian, Yongqiang An, Sheng Wang, Mingqi Zheng","doi":"10.1007/s10286-026-01199-z","DOIUrl":"10.1007/s10286-026-01199-z","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated the relationship between short-term blood pressure variability (BPV), autonomic function measured by heart rate variability (HRV), and the prevalence of complex arrhythmias in hypertensive patients.</p><p><strong>Methods: </strong>We retrospectively analyzed 198 middle-aged and elderly patients with primary hypertension, stratified by tertiles of 24-h systolic BPV. Simultaneous 24-h ambulatory blood pressure and Holter monitoring were performed. Echocardiography was performed within 72 h of monitoring. HRV was analyzed in time and frequency domains, and a composite autonomic score was derived via principal component analysis. Complex arrhythmia was defined as Lown grade ≥ 3 or Kleiger grade ≥ 3.</p><p><strong>Results: </strong> The high-BPV group showed significantly reduced HRV across all indices and a higher incidence of complex arrhythmias (71.2% versus 40.9% in low-BPV group). BPV was inversely correlated with all HRV parameters, most strongly with SDNN. Multivariate analysis confirmed BPV as an independent negative predictor of the composite autonomic score. Logistic regression adjusted for medication use identified higher BPV, older age, and larger left atrial diameter as independent predictors of complex arrhythmias.</p><p><strong>Conclusions: </strong>Increased short-term BPV is independently associated with impaired cardiac autonomic function and is a significant predictor of complex arrhythmias in hypertension. Assessment of BPV may improve autonomic and arrhythmic risk stratification in this population.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"387-398"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147519932","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":"Recognizing neurogenic bladder in diabetes: a call for early detection and multidisciplinary approach.","authors":"Mafalda Mesquita-Guimarães, Luís Sousa, Diogo Ferreira, Isabel Marantes","doi":"10.1007/s10286-025-01182-0","DOIUrl":"10.1007/s10286-025-01182-0","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"409-411"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910500","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.","authors":"Peter Novak","doi":"10.1007/s10286-026-01201-8","DOIUrl":"10.1007/s10286-026-01201-8","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"399-400"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147472821","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":"Rome was not built in a day, nor is a resilient clinical autonomic care unit.","authors":"Mario Habek, Alessandra Fanciulli, Magdalena Krbot Skorić, Roland D Thijs","doi":"10.1007/s10286-026-01208-1","DOIUrl":"10.1007/s10286-026-01208-1","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"401-403"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590351","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":"An alternative \"Port\"? Rationale and development process for POts Reprocessing Therapy (PORT), a brain-body therapy for postural tachycardic syndrome (POTS).","authors":"Taylor B Crouch, Maggie Nguyen, Mary Wells, Tammy Redman, Yoni Ashar, Howard Schubiner, Grace Westcott, Patricia Kinser, Madison Maxwell, Gisela Chelimsky, Thomas Chelimsky","doi":"10.1007/s10286-026-01189-1","DOIUrl":"10.1007/s10286-026-01189-1","url":null,"abstract":"<p><strong>Purpose: </strong>Postural tachycardia syndrome (POTS) is a chronic disorder marked by excessive orthostatic tachycardia, without clear structural/organic (e.g., cardiovascular) etiology. Recent evidence suggests that persistent autonomic symptoms may be driven by threat-induced and central nervous system-maintained dysregulation, similar to centralized chronic pain disorders. This study describes the rationale and development process of a brain-body intervention-POts Reprocessing Therapy (PORT)-aimed at reducing orthostatic symptomatology by taking advantage of the brain's plasticity.</p><p><strong>Methods: </strong>PORT was adapted from pain reprocessing therapy (PRT), an evidence-based mind-body approach for treating centralized chronic pain. The initial protocol was developed through consultations with multidisciplinary experts, including the developers of PRT. To refine the protocol, a focus group was conducted with five women participants with POTS who underwent an early version of PORT. Rapid qualitative analysis was conducted to identify themes and inform intervention improvements.</p><p><strong>Results: </strong>The intervention consists of a medical evaluation followed by eight weekly treatment sessions. Intervention components include psychoeducation, safety learning-based exposure to symptoms, somatic inquiry, and emotional processing. Focus group participants identified reduced fear about symptoms, greater understanding of their condition, and improved functioning. Participants provided suggestions around language and content, and some shared emotional challenges of the treatment, underscoring the need for sensitive provider communication and implementation.</p><p><strong>Conclusion: </strong>This study introduces a novel therapeutic treatment for POTS that targets centrally mediated processes hypothesized to underlie persistent autonomic dysregulation. Trials are underway to formally assess feasibility, acceptability, and efficacy.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"373-385"},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13265598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147303023","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":"Symptoms are an optimal target for orthostatic hypotension screening and management: an argument in favor.","authors":"Jose Ricardo Lopez Castellanos","doi":"10.1007/s10286-026-01213-4","DOIUrl":"10.1007/s10286-026-01213-4","url":null,"abstract":"<p><p>Orthostatic hypotension (OH), defined as a sustained reduction of ≥ 20 mmHg in systolic or ≥ 10 mmHg in diastolic blood pressure within 3 minutes of standing, represents one of the most clinically significant manifestations of autonomic failure. Beyond its hemodynamic definition, OH is associated with disabling symptoms, falls, syncope, reduced quality of life, increased healthcare utilization, and excess mortality. In clinical practice, management often requires balancing objective blood pressure measurements with the patient's lived experience of orthostatic intolerance. This viewpoint argues that symptoms represent an appropriate and clinically meaningful target for screening and management of OH. Three central assumptions support this perspective. First, patients are reliable reporters of orthostatic symptoms and clinicians are capable interpreters of these reports. Validated patient-reported outcome measures, such as the Orthostatic Hypotension Questionnaire (OHQ), demonstrate that symptom burden and functional impairment can be reproducibly quantified and that clinically meaningful changes can be detected. Second, although the relationship between orthostatic blood pressure changes and symptoms is not absolute, evidence supports a clinically relevant association, with symptomatic individuals often experiencing greater cerebral hypoperfusion when upright. Third, symptoms serve as a practical proxy for meaningful OH-related outcomes, including functional independence, fall risk, and quality of life, and have been accepted as primary endpoints in pivotal clinical trials. A symptom-centered framework complements objective hemodynamic assessment by contextualizing physiological findings within patients' functional experience. Integrating symptom reporting with orthostatic measurements provides a pragmatic, patient-centered approach to screening, treatment decisions, and evaluation of therapeutic response in OH.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"321-324"},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13265585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728826","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":"Heart rate variability provides prognostic value in multiple system atrophy.","authors":"Paulo Bastos, Marc Kermorgant, Margherita Fabbri, Frederic Roche, Vincent Pichot, Fabienne Ory-Magne, Clémence Leung, Olivier Rascol, Wassilios G Meissner, Alexandra Foubert-Samier, David Bendetowicz, Cécile Proust Lima, Anne Pavy-le-Traon","doi":"10.1007/s10286-026-01190-8","DOIUrl":"10.1007/s10286-026-01190-8","url":null,"abstract":"<p><strong>Purpose: </strong>Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by autonomic dysfunction, parkinsonism, and cerebellar impairment. Understanding the physiological correlates of disease severity and survival remains challenging due to heterogeneity in disease progression. Heart rate variability (HRV) is a noninvasive measure of autonomic nervous system function. However, the role of nonlinear HRV in MSA remains incompletely understood.</p><p><strong>Methods: </strong>This study investigated the association between HRV features, clinical severity, and survival in MSA (n = 214). Regression models were used to examine relationships between HRV and disease severity assessed by the Unified MSA Rating Scale (UMSARS), as well as time to death. Survival analyses evaluated the contribution of HRV features to risk stratification, and mediation analysis explored the relationships among HRV, UMSARS, and survival.</p><p><strong>Results: </strong>HRV features were negatively associated with disease severity, consistent with progressive autonomic dysfunction. While individual HRV features showed limited associations with UMSARS, their combination demonstrated a stronger relationship. Models incorporating HRV features showed associations with time to death comparable to those based on UMSARS, and the combined inclusion of HRV and UMSARS was associated with improved accuracy. Mediation analyses suggested that HRV captures physiological information related to survival that is not fully reflected by clinical severity scores.</p><p><strong>Conclusions: </strong>HRV features are associated with disease severity and survival in MSA and provide complementary physiological information beyond established clinical scales. These findings support the relevance of HRV as an exploratory modeling tool for autonomic dysfunction in MSA and highlight candidate features for future longitudinal and validation studies, rather than establishing a validated prognostic model.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"347-365"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147275776","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":"From \"evidence is scarce\" to trial-ready care pathways in POTS: an audit-ready roadmap prompted by Schiweck et al.","authors":"M Vijayasimha, M Srikanth","doi":"10.1007/s10286-026-01204-5","DOIUrl":"10.1007/s10286-026-01204-5","url":null,"abstract":"<p><p>Postural orthostatic tachycardia syndrome (POTS) represents a growing clinical and public health challenge, particularly in the context of post-infectious and post-COVID-19 syndromes. Recent systematic synthesis highlights that, despite widespread clinical use of pharmacologic and non-pharmacologic interventions, high-certainty randomized evidence remains scarce and heterogeneous. In this correspondence, prompted by contemporary treatment reviews, we argue that the primary limitation is no longer the absence of therapies but the absence of decision-grade trial architecture. We propose an audit-ready, globally scalable framework that integrates phenotype-stratified pragmatic trials, platform-based comparative effectiveness designs, and a minimum core outcome set anchored to minimally clinically important differences. Emphasis is placed on patient-relevant functional recovery, interpretability across health systems, and equitable implementation beyond tertiary autonomic centers.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"423-424"},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147572820","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":"Adult-onset spontaneous periodic hypothermia with hyperhidrosis: three cases of a Shapiro syndrome variant.","authors":"Rubens Paulo Salomão, Marcelo Rodrigues Masruha, José Luiz Pedroso, Orlando G P Barsottini","doi":"10.1007/s10286-026-01202-7","DOIUrl":"10.1007/s10286-026-01202-7","url":null,"abstract":"","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"413-415"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764147","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":"Setting up an autonomic unit within the neurological department: a position statement of the European Federation of Autonomic Societies.","authors":"Mario Habek, Alessandra Fanciulli, Anne Pavy-Le Traon, Walter Struhal, Magdalena Krbot Skorić, Luka Crnošija, Ivan Adamec, Marco Bozzali, Cristian Falup-Pecurariu, Jens Jordan, Evert Kaal, Gregor K Wenning, Giovanna Calandra Buonaura, Giacomo Chiaro, Pietro Cortelli, Pietro Guaraldi, Max J Hilz, Valeria Iodice, Astrid Juhl Terkelsen, Anita Kamondi, Marc Stefan Dawid Milner, Diogo Reis Carneiro, Camilla Rocchi, Isabel Rocha, Łukasz Rzepiński, Iva Stanković, Beatriz Tijero, Roland D Thijs","doi":"10.1007/s10286-026-01187-3","DOIUrl":"10.1007/s10286-026-01187-3","url":null,"abstract":"<p><strong>Purpose: </strong>The growing recognition of autonomic nervous system (ANS) dysfunction across a broad spectrum of neurological and systemic diseases calls for structured, multidisciplinary care. This position statement by the European Federation of Autonomic Societies aims to provide guidance on establishing an autonomic unit within a neurology department.</p><p><strong>Methods: </strong>A Task Force appointed by the European Federation of Autonomic Societies board in October 2022 proposed staffing and equipment requirements for autonomic units, based on a literature review, survey data from ANS laboratories, and existing diagnostic guidelines. These propositions were integrated into the initial 25 questions and refined using a modified Delphi method to achieve expert consensus. Consensus was predefined as ≥ 80% agreement. Statements that did not reach consensus were revised and reassessed in subsequent rounds.</p><p><strong>Results: </strong>After three rounds of Delphi surveys, expert consensus was achieved on the minimal and optimal requirements for autonomic unit personnel, technical equipment, and the availability of multidisciplinary care.</p><p><strong>Conclusion: </strong>This European Federation of Autonomic Societies position statement presents practical, expert-based recommendations to promote the development of autonomic units across various healthcare systems. By establishing minimum and optimal standards for staffing, equipment, and interdisciplinary collaboration, the document offers a clear framework for standardizing clinical care and supporting collaborative research. This statement serves as a foundational resource for clinicians, administrators, and policymakers committed to strengthening the ANS care infrastructure.</p>","PeriodicalId":10168,"journal":{"name":"Clinical Autonomic Research","volume":" ","pages":"325-340"},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13265601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149286","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}