Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance

Protheroe, Clare Louise; Ravensbergen, Henrike Rianne J C; Inskip, Jessica A.; Claydon, Victoria E.

doi:10.3791/4315

Cited by 26 publications

(27 citation statements)

References 60 publications

(86 reference statements)

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“…22 Furthermore, the Head-Up Tilt-Test is considered the gold standard for assessing and measuring OI. 23 During the physical examination, an appropriately sized cuff was placed on the upper arm of the participant and the participant was instructed to remain still and silent in a supine position for 5 min. At that time, blood pressure and pulse were measured with a sphygmomanometer.…”

Section: The Ascmentioning

confidence: 99%

Associations Between Autonomic and Orthostatic Self-report and Physician Ratings of Orthostatic Intolerance in Youth

Schultz

Katz

Bockian

et al. 2019

Clinical Therapeutics

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Purpose: There is no known biological marker or physical assessment to diagnose chronic fatigue syndrome (CFS), leaving physicians to heavily rely on self-report measures regarding the symptoms associated with CFS. Common symptoms of CFS include difficulty sleeping, joint pain, headaches, sore throat, cognitive dysfunction, physical exhaustion, dizziness, and nausea. Because of the overlap among CFS symptoms and autonomic functioning, we examined the association between 2 self-report measures of orthostatic and autonomic symptoms and a physician's report of autonomic functioning (measures of changes in blood pressure and pulse) to further understand the association among autonomic functioning within individuals with symptoms of CFS. Methods: With data from an ongoing study, we used independent t tests and Pearson correlation tests to assess the association among the orthostatic domain from the DePaul Symptom Questionnaire, Autonomic Symptom Checklist composite scores, and the physician's assessment of orthostatic intolerance obtained from a sample of 191 participants, 42 who were healthy controls. Findings: No significant demographic differences were found between the CFS-like group and the healthy controls. Results indicate a significant correlation between orthostatic and autonomic functioning (r ¼ 0.58) and a correlation with a low effect size among autonomic functioning and physician measures of orthostatic functioning (r ¼ −0.01 to 0.29). However, fewer correlations were found between self-reported symptoms of orthostatic functioning and the physician's measures of orthostatic functioning. Implications: These results suggest that although orthostatic dysfunction is reported in children and adolescents with CFS-like symptoms, the physical measures of autonomic functioning in this study were unable to detect these symptoms. (Clin Ther.

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Section: The Ascmentioning

confidence: 99%

Associations Between Autonomic and Orthostatic Self-report and Physician Ratings of Orthostatic Intolerance in Youth

Schultz

Katz

Bockian

et al. 2019

Clinical Therapeutics

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“…Therefore, increased retention of blood in the lower extremities upon passive tilting due to increased blood vessel elasticity and venous stasis can lead to POTS or OH depending on the extent and type of the connective tissue pathology. Additionally, the same mechanism predisposes to reflex syncope, which has been demonstrated in a study using negative lower body pressure during HUTT [18].…”

Section: Discussionmentioning

confidence: 58%

Association of Autonomic Nervous System Abnormalities on Head-Up Tilt Table Test with Joint Hypermobility

et al. 2018

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Aim: The aim of this study was to investigate the association of autonomic nervous system abnormalities on head-up tilt table test (HUTT) with generalized joint hypermobility, expressed by Beighton score (BS). Methods: This was a prospective study that included 115 consecutive patients (91 females; mean age 34.35 ± 14.11) referred either for the HUTT or testing of the cardiovascular autonomic reflexes together with HUTT. Generalized joint hypermobility was evaluated according to the BS system after which HUTT was performed. Clinically significant BS was considered if ≥4. Results: Fifteen patients (15.1%) had BS ≥4. Results of the HUTT were normal in 58 (50.4%) patients and in 57 (49.6%) patient HUTT was abnormal. Fifteen (13.0%) patients fulfilled criteria for orthostatic hypotension, 30 (26.1%) for reflex syncope and 21 (18.3%) for postural orthostatic tachycardia syndrome. Patients with pathological findings on HUTT had significantly higher BS compared to patients with normal HUTT (median 1 vs. 0, p = 0.001). There was a significant association between participants with BS ≥4 and pathological HUTT (χ[1] = 6.392, p = 0.011). Results of the multivariate regression analysis revealed that increase in the BS is associated with the increased likelihood of HUTT pathology (Exp[B] 1.44, 95% CI 1.084–1.922, p = 0.012), while increase in age is associated with lower risk of HUTT pathology (Exp[B] 0.968, 95% CI 0.939–0.998, p = 0.036). Conclusion: There is an association between autonomic nervous system abnormalities on HUTT test and generalized joint hypermobility.

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“…Head-up tilt testing, combined with lower body negative pressure (LBNP) is the gold standard for orthostatic tolerance testing, and can be used to determine orthostatic tolerance with a repeatability of 1.1 ± 0.6 min (Protheroe et al, 2013). In this randomized, single-blind (experimenter blind), placebo-controlled cross-over study, participants underwent three graded, 60 • HUT tests to presyncope with combined LBNP on three separate days.…”

Section: Methodsmentioning

confidence: 99%

Intermittent Calf Compression Delays the Onset of Presyncope in Young Healthy Individuals

Hockin

Claydon

2020

Front. Physiol.

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Orthostatic fluid shifts reduce the effective circulating volume and thus contribute to syncope susceptibility. Recurrent syncope has a devastating impact on quality of life and is challenging to manage effectively. To blunt orthostatic fluid shifts, static calf compression garments are often prescribed to patients with syncope, but have questionable efficacy. Intermittent calf compression, which mimics the skeletal muscle pump to minimize pooling and filtration, holds promise for the management of syncope. We aimed to evaluate the effectiveness of intermittent calf compression for increasing orthostatic tolerance (OT; time to presyncope). We conducted a randomized single-blind crossover study, in which participants (n = 21) underwent three graded 60 • headup-tilt tests to presyncope with combined lower body negative pressure on separate days. Low frequency intermittent calf compression (ICLF; 4 s on and 11 s off) at 0-30 and 0-60 mmHg was applied during two tests and compared to a placebo condition where the garment was fitted, but no compression applied. We measured continuous leg circumference changes (strain gauge plethysmography), cardiovascular responses (finger plethysmography; Finometer Pro), end tidal gases (nasal cannula), and cerebral blood flow velocity (CBFv, transcranial Doppler). The 0-60 mmHg ICLF increased OT (33 ± 2.2 min) compared to both placebo (26 ± 2.4 min; p < 0.001) and 0-30 mmHg ICLF (25 ± 2.7 min; p < 0.001). Throughout testing 0-60 mmHg ICLF reduced orthostatic fluid shifts compared to both placebo and 0-30 mmHg ICLF (p < 0.001), with an associated improvement in stroke volume (p < 0.001), allowing blood pressure to be maintained at a reduced heart rate (p < 0.001). In addition, CBFv was higher with 0-60 mmHg ICLF than 0-30 mmHg ICLF and placebo (p < 0.001). Intermittent calf compression is a promising novel intervention for the management of orthostatic intolerance, which may provide affected individuals renewed independence and improved quality of life.

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Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance

Cited by 26 publications

References 60 publications

Associations Between Autonomic and Orthostatic Self-report and Physician Ratings of Orthostatic Intolerance in Youth

Associations Between Autonomic and Orthostatic Self-report and Physician Ratings of Orthostatic Intolerance in Youth

Association of Autonomic Nervous System Abnormalities on Head-Up Tilt Table Test with Joint Hypermobility

Intermittent Calf Compression Delays the Onset of Presyncope in Young Healthy Individuals

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