Postural Orthostatic Tachycardia Syndrome: The Mayo Clinic Experience

Thieben, Mark J.; Sandroni, Paola; Sletten, David M.; Benrud-Larson, Lisa M.; Fealey, Robert D.; Vernino, Steven; Lennon, Vanda A.; Shen, Win Kuang; Low, Phillip A.

doi:10.4065/82.3.308

Cited by 272 publications

(374 citation statements)

References 23 publications

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“…Contrasting with previous studies [1,5] a precipitating event was present only in a quarter of patients, probably due to recall bias (given the long FUP time).…”

Section: Discussioncontrasting

confidence: 84%

“…More than half of patients (even though fewer than in other series [5]) had non-pharmacologic treatment with variable efficacy. Surprisingly, increment in aerobic exercise and resistance training, an important adjuvant measure [3,5], was not reported by any patients.…”

Section: Discussionmentioning

confidence: 96%

“…POTS affects predominantly young females, typically aged between 15 and 50 years [3], with a female:male ratio of 4-5:1 [2,3,5] and its exact prevalence is unknown [2]. POTS's clinical presentation is heterogeneous and nonspecific, probably reflecting multiple underlying pathophysiological mechanisms [3].…”

Section: Introductionmentioning

confidence: 99%

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Long-term follow-up of patients with postural tachycardia syndrome

et al. 2011

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Postural tachycardia syndrome (POTS) refers to the presence of orthostatic intolerance symptoms with a heart rate increment ≥ 30 bpm, usually up to ≥ 120 bpm. Pathophysiology and POTS's clinical presentation are heterogeneous and its prognosis is uncertain. We reviewed the major clinical characteristics of POTS patients and assessed their long-term follow-up. Our series results, one with the longest follow-up, illustrate POTS as a clinical entity with variable, but usually benign outcome, in which most patients can reassume their daily activities without great limitations, after proper diagnosis and treatment are made.

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“…Contrasting with previous studies [1,5] a precipitating event was present only in a quarter of patients, probably due to recall bias (given the long FUP time).…”

Section: Discussioncontrasting

confidence: 84%

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

Long-term follow-up of patients with postural tachycardia syndrome

et al. 2011

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“…Therefore, elevated expression of antibodies to gAChR subunits may contribute to secondary autoimmune responses to ganglionic neuron damage in seropositive patients. The prevalence of anti‐gAChR antibodies in this study was higher than that in previous study 17. Anti‐gAChR antibodies may impair autonomic ganglionic synaptic transmission, and antibodies that interfere with ganglionic transmission may contribute to dysautonomia in patients with POTS 18.…”

Section: Discussioncontrasting

confidence: 65%

Autoimmune postural orthostatic tachycardia syndrome

Watari

Nakane

Mukaino

et al. 2018

Ann Clin Transl Neurol

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The aim of this study was to evaluate the association between postural orthostatic tachycardia syndrome (POTS) and circulating antiganglionic acetylcholine receptor (gAChR) antibodies. We reviewed clinical assessments of Japanese patients with POTS, and determined the presence of gAChR antibodies in serum samples from those patients. Luciferase immunoprecipitation systems detected anti‐gAChR α3 and β4 antibodies in the sera from POTS (29%). Antecedent infections were frequently reported in patients in POTS patients. Moreover, autoimmune markers and comorbid autoimmune diseases were also frequent in seropositive POTS patients. Anti‐gAChR antibodies were detectable in significant number of patients with POTS, and POTS entailed the element of autoimmune basis.

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“…These autoantibodies likely will affect cardiovascular function at their putative sites of action. Other groups have recently provided data confirming this hypothesis 20, 21, 22…”

Section: Discussionmentioning

confidence: 61%

Angiotensin II Type 1 Receptor Autoantibodies in Postural Tachycardia Syndrome

Murphy

et al. 2018

JAHA

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BackgroundBoth the adrenergic and renin‐angiotensin systems contribute to orthostatic circulatory homeostasis, which is impaired in postural orthostatic tachycardia syndrome (POTS). Activating autoantibodies to the α1‐adrenergic and β1/2‐adrenergic receptors have previously been found in sera from patients with POTS. We hypothesized that patients with POTS might also harbor activating autoantibodies to the angiotensin II type 1 receptor (AT1R) independently of antiadrenergic autoimmunity. This study examines a possible pathophysiological role for AT1R autoantibodies in POTS.Methods and ResultsSerum immunoglobulin G from 17 patients with POTS, 6 patients with recurrent vasovagal syncope, and 10 normal controls was analyzed for the ability to activate AT1R and alter AT1R ligand responsiveness in transfected cells in vitro. Of 17 subjects with POTS, 12 demonstrated significant AT1R antibody activity in immunoglobulin G purified from their serum. No significant AT1R antibody activity was found in the subjects with vasovagal syncope or healthy subjects. AT1R activation by POTS immunoglobulin G was specifically blocked by the AT1R blocker losartan. Moreover, POTS immunoglobulin G significantly shifted the angiotensin II dosage response curve to the right, consistent with an inhibitory effect. All subjects with POTS were positive for one or both autoantibodies to the AT1R and α1‐adrenergic receptor.ConclusionsMost patients with POTS harbor AT1R antibody activity. This supports the concept that AT1R autoantibodies and antiadrenergic autoantibodies, acting separately or together, may exert a significant impact on the cardiovascular pathophysiological characteristics in POTS.

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Postural Orthostatic Tachycardia Syndrome: The Mayo Clinic Experience

Cited by 272 publications

References 23 publications

Long-term follow-up of patients with postural tachycardia syndrome

Long-term follow-up of patients with postural tachycardia syndrome

Autoimmune postural orthostatic tachycardia syndrome

Angiotensin II Type 1 Receptor Autoantibodies in Postural Tachycardia Syndrome

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