Gender differences in circulatory adjustment to head-up tilt test in health

Background: A tilt table test is a useful, non-invasive technique that has been used for the last few decades to detect autonomic failure. The response to tilting may vary physiologically between sexes. Aim of the study: To assess the gender-specific changes in cardiovascular response to a tilt test in healthy subjects. Materials and Methods: This experimental study was conducted on 90 healthy males and females aged 18 - 60 years, from 2019 to 2020. Forty- five male subjects and 45 female subjects were included. Using a motorized tilt table, a tilt table test was performed at 60 degrees for 10 minutes. An automatic sphygmomanometer was used to measure blood pressure (BP), and heart rate (HR) and a pulse oximeter was used for the measurement of peripheral capillary oxygen saturation (SpO2). An independent sample t test, a multiple regression analysis and a chi squared test were conducted for statistical analyses. Results: A significantly greater drop in systolic blood pressure (SBP) was observed in females, compared to males after tilting. In 5.5% of the subjects, orthostatic intolerance occurred, but there were no significant age or gender- specific differences in subjects with orthostatic intolerance. Conclusion: This study concluded that in response to tilting, cardiovascular response was less pronounced in females.

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Relation of body mass index (BMI) with cardiovascular response to head up tilt in healthy subjects

Journal of Bangladesh Society of Physiologist ◽

10.3329/jbsp.v15i1.48109 ◽

2020 ◽

Vol 15 (1) ◽

pp. 6-10

Author(s):

Sadia Afrin Rimi ◽

Shamima Sultana ◽

Iffat Rezwana ◽

Sultana Ferdousi

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Systolic Blood Pressure ◽

Healthy Subjects ◽

Cardiovascular Response ◽

Tilt Test ◽

Tilt Table ◽

Chi Square ◽

Female Head ◽

Head Up Tilt

Background: Tilt table test is used for the last few decades to detect cause in unexplained syncope. The response to tilting may vary physiologically with obesity. Objective: To assess the relationship of BMI to cardiovascular response to tilting. Methods: This experimental study was conducted from March 2019 to Feb 2020 on 90 healthy subjects with different BMI. Fifty one subjects of both gender with BMI 18.5-24.9 kg/m2 were included in the non-obese group and 39 subjects of both gender with BMI of 25-29.9 kg/m2 were included in overweight group and they were further subdivided into male and female. Head up tilting was done for 10 minutes at 600 by using a motorized tilt table. Systolic blood pressure (SBP), diastolic blood pressure (DBP) were recorded by an automatic sphygmomanometer. Heart rate (HR) and peripheral capillary oxygen saturation (SpO2) were measured by a pulse oximeter. For statistical analysis, Independent sample ‘t’ test, Pearson’s correlation test and Chi square tests were applied. Results: Significantly smaller rise of heart rate was observed in overweight males and greater fall of systolic blood pressure was observed in overweight females. Conclusion: This study concluded that over weight is associated with reduced orthostatic tolerance to head up tilt test in both genders. J Bangladesh Soc Physiol. 2020, June; 15(1): 6-10

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Interesting presentation of a broad complex tachycardia during the head up tilt table test

BMJ Case Reports ◽

10.1136/bcr-2021-245083 ◽

2021 ◽

Vol 14 (10) ◽

pp. e245083

Author(s):

Muhammad Taha Khan ◽

Aamir Hameed ◽

Yawer Saeed

Keyword(s):

Differential Diagnosis ◽

Ventricular Tachycardia ◽

Tilt Test ◽

3D Mapping ◽

Tilt Table Test ◽

Tilt Table ◽

Head Up Tilt ◽

Unusual Occurrence ◽

Head Up Tilt Test ◽

Broad Complex

Broad complex tachycardia (BCT) during head up tilt test (HUTT) is infrequent. Electrophysiology Study (EPS) plays an important part in further differentiation of BCT. We present a case of BCT during HUTT in a patient presenting with presyncope which later on EPS with 3D mapping was diagnosed as ventricular tachycardia. This case highlights the unusual occurrence of BCT during HUTT, the differential diagnosis of BCT and the utility of EPS to reliably identify the type and origin of BCT.

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Phenotypical evidence for a gender difference in cardiac norepinephrine transporter function

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00689.2003 ◽

2004 ◽

Vol 286 (5) ◽

pp. R851-R856 ◽

Cited By ~ 30

Author(s):

Christoph Schroeder ◽

Frauke Adams ◽

Michael Boschmann ◽

Jens Tank ◽

Sebastian Haertter ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Gender Difference ◽

Orthostatic Intolerance ◽

Cardiovascular Response ◽

Pressor Response ◽

Low Frequency ◽

Cold Pressor ◽

Norepinephrine Transporter ◽

Tilt Test

Norepinephrine transporter (NET) function has a central role in the regulation of synaptic norepinephrine concentrations. Clinical observations in orthostatic intolerance patients suggest a gender difference in NET function. We compared the cardiovascular response to selective NET inhibition with reboxetine between 12 healthy men and 12 age-matched women. Finger blood pressure, brachial blood pressure, and heart rate were measured. The subjects underwent cardiovascular autonomic reflex testing and a graded head-up tilt test. In a separate study, we applied incremental concentrations of tyramine and isoproterenol through subcutaneous microdialysis catheters in eight men and in eight women. NET inhibition elicited a threefold greater increase in supine blood pressure in men than women ( P < 0.05). The pressor response was driven by an increased cardiac output. The orthostatic heart rate increase during NET inhibition was greater in men than women (56 ± 5 beats/min in men, 42 ± 4 beats/min in women, P < 0.001). In contrast, NET inhibition resulted in a similar suppression in the cold pressor and handgrip response, low-frequency blood pressure oscillations, and venous norepinephrine in the supine position. Men and women were similarly sensitive to the lipolytic effect of isoproterenol and tyramine. We conclude that NET inhibition results in more pronounced changes in cardiac regulation in men than women. Our observations suggest that the NET contribution to cardiac norepinephrine turnover may be decreased in women. The gender difference in NET function may not be expressed in tissues that are less NET dependent than the heart.

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Detailed Relationship Between the Pattern of Blood Pressure Change During the Valsalva Maneuver and the Degree of Orthostatic Hypotension During the Head-Up Tilt Test in Patients With Orthostatic Intolerance

Medicine ◽

10.1097/md.0000000000003608 ◽

2016 ◽

Vol 95 (19) ◽

pp. e3608 ◽

Cited By ~ 7

Author(s):

Hyun-Ah Kim ◽

Hyon-Ah Yi ◽

Jeong-Ho Hong ◽

Hyung Lee

Keyword(s):

Blood Pressure ◽

Orthostatic Hypotension ◽

Orthostatic Intolerance ◽

Valsalva Maneuver ◽

Pressure Change ◽

Blood Pressure Change ◽

Tilt Test ◽

Head Up Tilt ◽

Head Up Tilt Test

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Baseline adenosine plasma levels indicate differential response to adenosine test and head-up tilt test in syncopal patients

European Heart Journal ◽

10.1093/ehjci/ehaa946.0704 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Sotiriadou ◽

A Antoniadis ◽

S Vergopoulos ◽

C Lazaridis ◽

P Konstantinidis ◽

...

Keyword(s):

Structural Heart Disease ◽

Tilt Test ◽

Tilt Table Test ◽

Tilt Table ◽

High Baseline ◽

Pearson's R ◽

Head Up Tilt ◽

Head Up Tilt Test ◽

Precise Role ◽

Pearson’S R

Abstract Background/Introduction Head-up tilt table test (HUTT) and Adenosine test (ADT) can be useful in the diagnostic evaluation of syncope. Adenosine plasma (ADP) and Adenosine receptor (ADR) levels may differentiate the outcomes of HUTT and ADT but their precise role in the risk stratification of patients with syncope remains elusive. Purpose We sought to assess the ADP and ADR levels in patients without structural heart disease who underwent HUTT and ADT tests as part of the diagnostic workup of syncope. We specifically investigated differences in the outcomes of the HUTT and ADT tests as well as to the ADP levels during HUTT according to the baseline ADP levels. Methods HUTT and ADT were performed as per the standard protocols. ADT was considered positive in the event of asystole >6 seconds or heart block for >10 seconds after intravenous Adenosine 0.15 mg/kg administration in the supine position. ADP levels (ppm/Um/L) were assessed at three timepoints during the HUTT: at baseline (supine), immediately after bed tilt and, in cases of a positive HUTT, at the time of syncope. Patients were categorized in terciles of low, intermediate and high baseline ADP levels. We also assessed the A2A ADR levels of monocytes. Results We prospectively analyzed 106 patients (62 women, age 46.87±20.63 years). ADT was positive in 14.2% of patients and HUTT in 47.2% of patients. Females were more likely to have low ADP levels (odds ratio [OR] 2.70, 95% Confidence Interval [CI] 1.04 to 6.94, p<0.05). Patients with low baseline ADP levels showed a trend for positive ADT (OR 3.15, 95% CI 1.05 to 10.85, p=0.07), while patients with high baseline ADP levels showed a trend for negative HUTT (OR 2.35, 95% CI 0.94 to 5.90, p=0.075). Within patients with positive HUTT, those with low baseline ADP levels, showed an increase in ADP in the tilt phase (0.063 vs 0.027 ppm/Um/L, p<0.05) but not at the time of syncope (0.045 ppm/Um/L) while those with intermediate baseline ADP levels showed an increase in ADP in the tilt phase (0.16 vs 0.095 ppm/Um/L, p<0.05) which persisted during syncope (0.18 ppm/Um/L, p<0.05). Patients with high baseline ADP levels did not exhibit differences in ADP during positive HUTT. Higher baseline ADP levels were associated with smaller increases in the tilt phase (Pearson's r −0.621, p<0.001). ADR levels in patients with positive HUTT correlated positively with baseline ADP levels (Pearson's r 0.878, p<0.001). Conclusion(s) Baseline ADP levels may be related to the outcome of ADT and HUTT. ADP increases during HUTT except for patients with high baseline ADP. ADP and ADR levels warrant further investigation as they may characterize a subset of patients with specific responses to HUTT and may be implicated in the pathophysiology of reflex syncope. Funding Acknowledgement Type of funding source: None

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223 The bradycardia-hypotension reaction during head-up tilt test in patients with syncope: prevalence and value of blood pressure and heart rate behavior during the early stage of the test

EP Europace ◽

10.1016/s1099-5129(05)80134-5 ◽

2005 ◽

Vol 7 ◽

pp. 45-45

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Early Stage ◽

Tilt Test ◽

Head Up Tilt ◽

Rate Behavior ◽

Head Up Tilt Test

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Refined Multiscale Fuzzy Entropy to Analyse Post-Exercise Cardiovascular Response in Older Adults With Orthostatic Intolerance

Entropy ◽

10.3390/e20110860 ◽

2018 ◽

Vol 20 (11) ◽

pp. 860 ◽

Cited By ~ 3

Author(s):

Marcos Hortelano ◽

Richard Reilly ◽

Francisco Castells ◽

Raquel Cervigón

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Orthostatic Intolerance ◽

Cardiovascular Response ◽

Recovery Period ◽

The Elderly ◽

Fuzzy Entropy ◽

Post Exercise ◽

And Gender ◽

Risk Factors For Falls

Orthostatic intolerance syndrome occurs when the autonomic nervous system is incapacitated and fails to respond to the demands associated with the upright position. Assessing this syndrome among the elderly population is important in order to prevent falls. However, this problem is still challenging. The goal of this work was to determine the relationship between orthostatic intolerance (OI) and the cardiovascular response to exercise from the analysis of heart rate and blood pressure. More specifically, the behavior of these cardiovascular variables was evaluated in terms of refined composite multiscale fuzzy entropy (RCMFE), measured at different scales. The dataset was composed by 65 older subjects, 44.6% (n = 29) were OI symptomatic and 55.4% (n = 36) were not. Insignificant differences were found in age and gender between symptomatic and asymptomatic OI participants. When heart rate was evaluated, higher differences between groups were observed during the recovery period immediately after exercise. With respect to the blood pressure and other hemodynamic parameters, most significant results were obtained in the post-exercise stage. In any case, the symptomatic OI group exhibited higher irregularity in the measured parameters, as higher RCMFE levels in all time scales were obtained. This information could be very helpful for a better understanding of cardiovascular instability, as well as to recognize risk factors for falls and impairment of functional status.

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Pulsed Wave Doppler Ultrasound Is Useful to Assess Vasomotor Response in Patients with Multiple System Atrophy and Well Correlated with Tilt Table Study

The Scientific World JOURNAL ◽

10.1100/2012/548529 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Ke-Vin Chang ◽

Wen-Shiang Chen ◽

Ruey-Meei Wu ◽

Ssu-Yuan Chen ◽

Hsiu-Yu Shen ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Correlation Analysis ◽

Multiple System Atrophy ◽

Cardiovascular Response ◽

Vasomotor Response ◽

Tilt Table ◽

Hemodynamic Variables ◽

Pulsed Wave Doppler ◽

Head Up Tilt

The study aim was to assess sympathetic vasomotor response (SVR) by using pulsed wave Doppler (PWD) ultrasound in patients with multiple system atrophy (MSA) and correlate with the tilt table study. We recruited 18 male patients and 10 healthy men as controls. The SVR of the radial artery was evaluated by PWD, using inspiratory cough as a provocative maneuver. The response to head-up tilt was studied by a tilt table with simultaneous heart rate and blood pressure recording. The hemodynamic variables were compared between groups, and were examined by correlation analysis. Regarding SVR, MSA patients exhibited a prolonged latency and less heart rate acceleration following inspiratory cough. Compared with the tilt table test, the elevation of heart rate upon SVR was positively correlated to the increase of heart rate after head-up tilt. The correlation analysis indicated that the magnitude of blood pressure drop from supine to upright was positively associated with the SVR latency but negatively correlated with the heart rate changes upon SVR. The present study demonstrated that blunted heart rate response might explain MSA's vulnerability to postural challenge. PWD may be used to predict cardiovascular response to orthostatic stress upon head-up tilt in MSA patients.

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Patients with reflex syncope have a higher prevalence of atrial fibrillation than general population which is predicted by the type of the tilt table test response

European Heart Journal ◽

10.1093/eurheartj/ehab724.0325 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

J M Farinha ◽

L Parreira ◽

A F Esteves ◽

M Fonseca ◽

A Pinheiro ◽

...

Keyword(s):

Atrial Fibrillation ◽

Nervous System ◽

Autonomic Nervous System ◽

General Population ◽

Tilt Test ◽

Tilt Table Test ◽

Tilt Table ◽

Test Response ◽

Reflex Syncope ◽

Vasodepressor Response

Abstract Introduction Reflex syncope is the result of an imbalance between the sympathetic and parasympathetic nervous system. The autonomic nervous system has been associated to some forms of atrial fibrillation (AF). Objective The aim of this study was to assess the prevalence of AF in patients with reflex syncope and a positive tilt table test and to identify the type of tilt test response in patients with AF in comparison to patients without AF. Methods We retrospectively studied consecutive patients that underwent a tilt table test at our institution between 2016 and 2019. We selected those patients with a positive test. Patients with an implanted pacemaker at the time of the tilt test and patients followed in a different institution were excluded. Previous diagnoses of AF episodes were assessed. We analysed the clinical characteristics and the tilt table test results according to previous history of AF. Results We studied 49 patients with a positive tilt test. Seven (14.3%) patients had previously diagnosed paroxysmal AF at the time of the tilt table test. Patients with AF were older, had more frequently hypertension, and the tilt test response was more frequently a vasodepressor than mixed or cardioinhibitory response (71.4% vs. 28.6%) (Table). In univariate analysis, age and hypertension were associated with AF, respectively, OR 1.08 (95% CI 1.01–1.17), p=0.034 and OR 10.80 (95% CI 1.19–98.36), p=0.035. A vasodepressor response was also associated with AF (OR 6.25, 95% CI 1.06–36.74, p=0.043). Conclusions Patients with reflex syncope and a positive tilt table test had a higher prevalence of AF than the general population. A vasodepressor response was associated with AF as were age and hypertension, demonstrating the possible impact of the autonomic nervous system and the multifactorial nature of AF. FUNDunding Acknowledgement Type of funding sources: None.

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