Document Detail

Beat-to-beat analysis of pressure wave morphology for pre-symptomatic detection of orthostatic intolerance during head-up tilt.
MedLine Citation:
PMID:  15519025     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The aim of this study was to noninvasively define the hemodynamic profile characterizing the early response to tilting. BACKGROUND: The mechanisms causing orthostatic intolerance have not been fully elucidated. Usually, patients undergoing tilt test are studied in a time-consuming way. Moreover, the test can cause discomfort to the patient and even be potentially hazardous. METHODS: Nineteen orthostatic intolerant patients (OIP), compared with 22 healthy subjects (HS), performed head-up tilt test while their arterial pressure waveform was noninvasively recorded. We elaborated data using the Pressure Recording Analytical Method to obtain hemodynamic parameters, then analyzing the variables by discriminant analysis. RESULTS: Compared with HS, OIP showed lower stroke volume index (SVI) values even in baseline conditions associated with higher values of systemic vascular resistance (SVR) and heart rate (HR). From the third minute of the tilted position and until symptoms appeared, patients exhibited lower values of blood pressure (BP) and SVI and higher HR values but no difference in SVR. At termination, patients showed a further significant reduction in BP and SVI and a persistent increase in HR. CONCLUSIONS: This investigation underlines: 1) the possibility of beat-to-beat monitoring of hemodynamic changes during tilting; 2) the cardiovascular profile of OIP at rest, characterized by lower SVI and higher SVR and HR; 3) the maladaptive response to postural challenge of OIP mainly identifiable in impaired vascular regulation; and 4) the possibility of detecting parameters that enable prompt identification of the positive response to tiltingin these patients, thus guiding the duration of the test.
Salvatore M Romano; Chiara Lazzeri; Marco Chiostri; Gian Franco Gensini; Franco Franchi
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  44     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-11-02     Completed Date:  2005-01-18     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1891-7     Citation Subset:  AIM; IM    
Department of Internal Medicine and Cardiology, University of Florence, School of Medicine, Florence, Italy.
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MeSH Terms
Atmospheric Pressure*
Blood Pressure / physiology
Dizziness / physiopathology*
Heart Rate / physiology
Hypotension, Orthostatic / physiopathology
Middle Aged
Myocardial Contraction / physiology
Statistics as Topic
Stroke Volume / physiology
Tilt-Table Test*
Time Factors
Vascular Resistance / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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