Orthostatic Changes in Hemodynamics and Cardiovascular Biomarkers in Dysautonomic Patients
Author(s)
Type
Journal Article
Abstract
Background
Impaired autonomic control of postural homeostasis results in orthostatic intolerance. However,
the role of neurohormones in orthostatic intolerance has not been explained.
Methods
Six-hundred-and-seventy-one patients (299 males; 55±22 years) with unexplained syncope
underwent head-up tilt (HUT) with serial blood sampling. Systolic blood pressure (SBP) and
heart rate (HR) supine, after 3min, and lowest BP/highest HR during HUT were recorded.
Plasma levels of epinephrine, norepinephrine, renin, C-terminal-pro-arginine-vasopressin
(CT-proAVP), C-terminal- endothelin-1 (CT-proET-1), and mid-regional-fragment of pro-atrial-natriuretic-peptide
(MR-proANP) were determined at supine and 3min of HUT. Multivariate-adjusted
logistic regression model was applied to compare 1st (reference) with 4th
quartile of 3 min and maximal ΔSBP/ΔHR (i.e. pronounced hypotension or tachycardia) vs.
changes in neuroendocrine biomarkers, respectively.
Results
Higher resting CT-proET-1 predicted BP fall at 3min (Odds ratio (OR) per 1 SD: 1.62, 95%
CI 1.18–2.22; p = 0.003), and max BP fall during HUT (1.82, 1.28–2.61; p = 0.001). Higher
resting CT-proAVP predicted BP fall at 3min (1.33, 1.03–1.73; p = 0.03), which was also associated
with increase in CT-proAVP (1.86, 1.38–2.51; p = 0.00005) and epinephrine (1.47,
1.12–1.92; p = 0.05) during HUT. Lower resting MR-proANP predicted tachycardia at 3min
(0.37, 0.24–0.59; p = 0.00003), and max tachycardia during HUT (0.47, 0.29–0.77; p =
0.002). Further, tachycardia during HUT was associated with increase in epinephrine (1.60,
1.15–2.21; p = 0.005), and norepinephrine (1.87, 1.38–2.53; p = 0.005). Conclusions
Resting CT-proET-1 and CT-proAVP are increased in orthostatic hypotension, while resting
MR-proANP is decreased in postural tachycardia. Moreover, early BP fall during orthostasis
evokes increase in CT-proAVP and epinephrine, while postural tachycardia is associated
with increase in norepinephrine and epinephrine.
Impaired autonomic control of postural homeostasis results in orthostatic intolerance. However,
the role of neurohormones in orthostatic intolerance has not been explained.
Methods
Six-hundred-and-seventy-one patients (299 males; 55±22 years) with unexplained syncope
underwent head-up tilt (HUT) with serial blood sampling. Systolic blood pressure (SBP) and
heart rate (HR) supine, after 3min, and lowest BP/highest HR during HUT were recorded.
Plasma levels of epinephrine, norepinephrine, renin, C-terminal-pro-arginine-vasopressin
(CT-proAVP), C-terminal- endothelin-1 (CT-proET-1), and mid-regional-fragment of pro-atrial-natriuretic-peptide
(MR-proANP) were determined at supine and 3min of HUT. Multivariate-adjusted
logistic regression model was applied to compare 1st (reference) with 4th
quartile of 3 min and maximal ΔSBP/ΔHR (i.e. pronounced hypotension or tachycardia) vs.
changes in neuroendocrine biomarkers, respectively.
Results
Higher resting CT-proET-1 predicted BP fall at 3min (Odds ratio (OR) per 1 SD: 1.62, 95%
CI 1.18–2.22; p = 0.003), and max BP fall during HUT (1.82, 1.28–2.61; p = 0.001). Higher
resting CT-proAVP predicted BP fall at 3min (1.33, 1.03–1.73; p = 0.03), which was also associated
with increase in CT-proAVP (1.86, 1.38–2.51; p = 0.00005) and epinephrine (1.47,
1.12–1.92; p = 0.05) during HUT. Lower resting MR-proANP predicted tachycardia at 3min
(0.37, 0.24–0.59; p = 0.00003), and max tachycardia during HUT (0.47, 0.29–0.77; p =
0.002). Further, tachycardia during HUT was associated with increase in epinephrine (1.60,
1.15–2.21; p = 0.005), and norepinephrine (1.87, 1.38–2.53; p = 0.005). Conclusions
Resting CT-proET-1 and CT-proAVP are increased in orthostatic hypotension, while resting
MR-proANP is decreased in postural tachycardia. Moreover, early BP fall during orthostasis
evokes increase in CT-proAVP and epinephrine, while postural tachycardia is associated
with increase in norepinephrine and epinephrine.
Date Issued
2015-06-08
Date Acceptance
2015-05-04
Citation
PLoS ONE, 2015, 10 (6)
ISSN
1932-6203
Publisher
Public Library of Science (PLoS)
Journal / Book Title
PLoS ONE
Volume
10
Issue
6
Copyright Statement
© 2015 Nilsson et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are
credited
access article distributed under the terms of the
Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are
credited
License URL
Subjects
Science & Technology
Multidisciplinary Sciences
Science & Technology - Other Topics
HEAD-UP TILT
NEURALLY-MEDIATED SYNCOPE
HUMAN-PLASMA
NEUROCARDIOGENIC SYNCOPE
IMMUNOLUMINOMETRIC ASSAY
NATRIURETIC-PEPTIDE
UNEXPLAINED SYNCOPE
VASOVAGAL SYNCOPE
HYPOTENSION
MANAGEMENT
Publication Status
Published
Article Number
e0128962