Squatting test: a dynamic postural manoeuvre to study baroreflex sensitivity

Scheen, André; Philips, Jean-Christophe

doi:10.1007/s10286-011-0140-8

Cited by 16 publications

(27 citation statements)

References 41 publications

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“…The transition from standing to squatting elicits muscle pumping and increased venous return, which leads to prompt increases in cardiac output, systolic BP, and pulse pressure (PP), followed by reflex bradycardia [ 12,19]. Bradycardia was shown to be significantly dampened by the administration of atropine in healthy volunteers, consistent with vagal activation [17], and was not observed in heart transplant recipients [20].…”

Section: Haemodynamic Changes During Squatting and The Squat-stand Trmentioning

confidence: 98%

“…Each transition provokes specific haemodynamic changes that can be monitored by a Finapres device, as recently described in detail elsewhere ( Fig. 1) [12].…”

Section: Haemodynamic Changes During Squatting and The Squat-stand Trmentioning

confidence: 99%

“…In normal, healthy subjects, cardiac output increases over the first 5 s after standing from squatting position due to compression of the leg and abdominal vessels. Rapid (within 15-20 s) BP recovery implies baroreflex stimulation [8], which is associated with tachycardia and secondary peripheral vasoconstriction [12,15]. Propranolol can markedly attenuate reflex tachycardia in normal subjects, suggesting that sympathetic activation plays a key role in this abrupt HR rise [17].…”

Section: Haemodynamic Changes During Squatting and The Squat-stand Trmentioning

confidence: 99%

“…The most commonly used tests are the lying-to-standing active manoeuvre in clinical practice, and the head-up 70°-tilt table test passive manoeuvre in clinical research [11]. Another active test, the so-called squat test, produces the strongest orthostatic stress [10,12], more so than the head-up tilt [10,13,14], and can therefore be used to assess autonomic dysfunction [15]. Indeed, careful analysis of BP and HR changes during the transitions from standing to squatting and, even more interesting, from squatting to standing, provides invaluable information [8].…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, careful analysis of BP and HR changes during the transitions from standing to squatting and, even more interesting, from squatting to standing, provides invaluable information [8]. The squat test can be used to assess autonomic dysfunction especially through calculation ofthe so-called baroreflex gain [12,15]. Our research group [16], as with others [13,17,18], was particularly interested in applying this original potent posture test to assess diabetic CAN.…”

Section: Introductionmentioning

confidence: 99%

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Squatting, a posture test for studying cardiovascular autonomic neuropathy in diabetes

Philips

Marchand

Scheen

2011

Diabetes & Metabolism

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Cardiovascular autonomic neuropathy (CAN) is a frequent complication of diabetes mellitus, which is associated with increased morbidity and mortality. It involves both the parasympathetic and sympathetic nervous systems, and may be diagnosed by classical dynamic tests with measurements of heart rate (HR) and/or arterial blood pressure (BP). An original squattest (1-min standing, 1-min squatting, 1-min standing) was used with continuous monitoring of HR and BP, using a Finapres ® device. This active test imposes greater postural stress than the passive head-up tilt test, and provokes large changes in BP and HR that can be analyzed to derive indices of CAN. In healthy subjects, squatting is associated with BP increases and HR decreases (abolished by atropine: SqTv index), whereas the squat-stand transition is accompanied by a deep but transient drop in BP associated with sympathetic-driven tachycardia (abolished by propranolol: SqTs index). In diabetic patients with CAN, BP increases are accentuated during squatting whereas reflex bradycardia is reduced. When standing from squatting position, the fall in BP tends to be more pronounced and orthostatic hypotension more prolonged, while reflex tachycardia is markedly dampened. The baroreflex gain, similar to that calculated during pharmacological testing with vasodilator/vasopressor agents, can be derived by plotting pulse intervals (R-R) against systolic BP levels during the biphasic response following the squat-stand transition. The slope, which represents baroreflex sensitivity, is significantly reduced in patients with CAN. This discriminatory index allows study of the natural history of CAN in a large cohort of diabetic patients.Keywords: Baroreflex sensitivity; Cardiovascular autonomic neuropathy; Finapres ; Squatting; Diabetes; Heart rate; Orthostatic hypotension; Posture test; Review RésuméTest postural d' accroupissement pour étudier la neuropathie autonome cardiovasculaire diabétique.La neuropathie autonome cardiaque (NAC) est une complication fréquente du diabète qui est associée à une augmentation de la morbidité et de la mortalité. Elle concerne à la fois les systèmes parasympathique et sympathique et peut être diagnostiquée classiquement par des tests dynamiques avec mesure des variations de la frequence cardiaque (FC) et de la pression artérielle (PA). Notre groupe a utilise un test postural original (1-min debout-1 -min accroupi ou « squatting »-1 -min debout) avec un monitorage continu de FC et PA avec un appareil Finapres ® . Ce test de redressement actif impose un stress postural plus prononcé que le test d'inclinaison passif sur une table basculante et provoque des variations amp les de PA et FC qui peuvent être analysées pour dériver des indices de NAC. Chez des sujets sains, le «squatting» entraîne une augmentation de PA et une diminution de FC (abolie par l'atropine : indice SqTv) alors que la transition accroupi-debout induit une chute importante mais transitoire de PA accompagnée d'une tachycardie d'origine sympathique (abolie par le ...

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Section: Haemodynamic Changes During Squatting and The Squat-stand Trmentioning

confidence: 98%

“…Each transition provokes specific haemodynamic changes that can be monitored by a Finapres device, as recently described in detail elsewhere ( Fig. 1) [12].…”

Section: Haemodynamic Changes During Squatting and The Squat-stand Trmentioning

confidence: 99%