Improvement in low upright baroreflex sensitivity is associated with positive clinical effect of orthostatic training

Mitro, Peter; Šimurda, Miloš; Muller, Ervin

doi:10.1111/pace.13238

Cited by 8 publications

(7 citation statements)

References 21 publications

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“…Others have also reported similar figures in normal subjects (83). The BRS has been found to be low even in resting conditions in those with poor orthostatic tolerance and the index does not change much on exposure to orthostatic stress (69,84). In fact it has been suggested that the defect may lie at the sensory receptor level where the changes in the pulsatile pressure are not sensed adequately (69).…”

Section: Baro Reflex Sensitivity (Brs) and Syncopementioning

confidence: 76%

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Current Concepts of Pathophysiology of Vasovagal Syncope and its Evaluation and Management: A Review

Dikshit

Jaju

2020

ANAMS

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Vasovagal syncope (VVS) with a sudden, temporary loss of consciousness (LoC) is a common phenomenon in the young and the elderly. Though generally described as innocuous, it may lead to serious consequences in special category of people (pilots), or in the elderly in whom LoC may lead to a fall and serious injury. The topic has been copiously researched upon and discussed in medical literature over the last few decades, but the exact mechanisms which lead to the disability have yet to be fully agreed upon. Changes in cardiovascular baroreceptor sensitivity, aberrations in the complex interaction amongst the nucleus of the tractus solitarius and the nuclei around it, inability of the peripheral circulation to respond to autonomic vasoconstrictors, or excess production of vasodilators such as nitric oxide produced locally have been considered in its pathophysiology. Various extraneous situations like dehydration, exposure to heat stress, medications, psychological factors may adversely stress regulatory physiological responses and promote occasional episodes of VVS. More complex dysautonomia could be a reason for the recurrent VVS. Differences between brain structure of VVS sufferers and normal subjects have been proposed. Head-up tilt table (HUT) test is the most widely applied investigation for evaluating VVS episodes. Lower body negative pressure (LBNP) has also been used. Enhancement of the orthostatic stress may be done by simultaneous use of both, or with peripheral vasodilators. As to whether such an enhancement is necessary is debatable. Management with increased salt and fluid intake, corticosteroids, beta adrenergic receptor blockers, alpha adrenergic receptor stimulants, selective serotonin reuptake inhibitors, and nitric oxide synthase inhibitors have been tried with variable success.

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Section: Baro Reflex Sensitivity (Brs) and Syncopementioning

confidence: 76%

“…There have been attempts to improve responses of patients with recurrent VVS by orthostatic training (84). Patients of VVS were asked to lean against a wall with their feet placed 15 cm away from the wall.…”

Section: Principles Of Management Of Vvsmentioning

confidence: 99%

Current Concepts of Pathophysiology of Vasovagal Syncope and its Evaluation and Management: A Review

Dikshit

Jaju

2020

ANAMS

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“…Detection of BRS is not only beneficial to patients who would potentially receive beta-blocker treatment but also to those receiving orthostatic training. Orthostatic training is considered to cure patients with VVS accompanied by sympathetic nervous dysfunction, another subset of patients with autonomic nervous activity alterations (Tan et al, 2010;Mitro et al, 2018). Both Tan et al and Mitro et al found that BRS was increased after the intervention of orthostatic training, and furthermore, Mitro et al identified that VVS patients with lower upright BRS had better outcomes than those with relatively higher values.…”

Section: Discussionmentioning

confidence: 99%

Baroreflex Sensitivity Predicts Response to Metoprolol in Children With Vasovagal Syncope: A Pilot Study

Tao

Tang

et al. 2019

Front. Neurosci.

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Objective: To explore the role of baroreflex sensitivity (BRS) in the head-up tilt test (HUTT) in predicting the therapeutic response of vasovagal syncope (VVS) patients to metoprolol. Materials and Methods: Vasovagal syncope patients treated with metoprolol were enrolled in this study and were classified as responders or non-responders according to changes in their symptom scores before and after metoprolol treatment. Values of BRS in the supine position and at positive response occurrence in the HUTT were obtained, and BRS changes from supine to positive response occurrence were calculated. Differences between responders and non-responders were analyzed. Receiver operating characteristic curve analysis was performed to assess the value of BRS for predicting the therapeutic efficacy of metoprolol in pediatric patients with VVS. Results: Forty patients (14 boys; 11.8 ± 2.5 years) diagnosed with VVS were recruited in the study, 28 of whom were verified to be responders to metoprolol and 12 of whom were verified as non-responders. They did not show any differences in baseline characteristics and hemodynamics in the HUTT (p > 0.05). However, the responders had an obviously increased supine BRS value compared to the non-responders (16.9 ± 7.7 ms/mmHg vs. 7.6 ± 3.8 ms/mmHg; p < 0.01). No difference in BRS at positive response occurrence was observed between the two groups (8.9 ± 8.5 ms/mmHg vs. 10.6 ± 9.8 ms/mmHg; p > 0.05). Accordingly, the changes in the BRS of responders were more obvious than in non-responders (8.0 ± 7.8 ms/mmHg vs. −3.0 ± 10.4 ms/mmHg; p < 0.01). The area under the receiver operating characteristic curve for the predictive value of supine BRS was 0.887 (95% CI, 0.779-0.995; p < 0.01). A cutoff value of 10 ms/mmHg yielded a sensitivity and specificity of 82 and 83%, respectively, in predicting the therapeutic efficacy of metoprolol in pediatric VVS patients.

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“…Abnormal changes in baroreceptors are one of the important pathogeneses of VVS. Measurements of baroreflex sensitivity (BRS) can evaluate the response to baroreceptors in the process of arterial pressure changes and reflect sympathetic nerve activity ( 6 ). The pre-treatment supine BRS of children with VVS to whom β-blockers are effective is much higher than that of children to whom β-blockers are ineffective.…”

Section: Individualized Beta-blocker Therapy For Children With Vvs: B...mentioning

confidence: 99%

“…Currently, known therapeutic methods of VVS include pharmacological and non-pharmacological therapies. Beta-blockers, α1-adrenergic receptor agonist, sertraline, fludrocortisone, and oral rehydration salts are commonly used pharmacological treatments for VVS ( 1 , 5 , 6 ). This review summarizes the latest advances of biomarkers that can predict the therapeutic efficacy of β-blocker in children with VVS, and points out the advantages and disadvantages of these biomarkers.…”

Section: Introductionmentioning

confidence: 99%

Markers for predicting the efficacy of beta-blockers in vasovagal syncope management in children: A mini-review

Wang

Liu²,

Jin³

et al. 2023

Front. Cardiovasc. Med.

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Vasovagal syncope (VVS) is a common subtype of neurally mediated syncope. It is prevalent in children and adolescents, and critically affects the quality of life of patients. In recent years, the management of pediatric patients with VVS has received extensive attention, and β-blocker serves as an important choice of the drug therapy for children with VVS. However, the empirical use of β-blocker treatment has limited therapeutic efficacy in patients with VVS. Therefore, predicting the efficacy of β-blocker therapy based on biomarkers related to the pathophysiological mechanism is essential, and great progress has been made by applying these biomarkers in formulating individualized treatment plans for children with VVS. This review summarizes recent advances in predicting the effect of β-blockers in the management of VVS in children.

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Improvement in low upright baroreflex sensitivity is associated with positive clinical effect of orthostatic training

Abstract: OT reduced symptoms in 74% patients who trained regularly. However, the compliance to training was low. Possible mechanism of OT is reconditioning effect on baroreceptor reactivity in upright position.

Cited by 8 publications

References 21 publications

Current Concepts of Pathophysiology of Vasovagal Syncope and its Evaluation and Management: A Review

Current Concepts of Pathophysiology of Vasovagal Syncope and its Evaluation and Management: A Review

Baroreflex Sensitivity Predicts Response to Metoprolol in Children With Vasovagal Syncope: A Pilot Study

Markers for predicting the efficacy of beta-blockers in vasovagal syncope management in children: A mini-review

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