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Near Infrared Spectroscopy: Guided Tilt Table Testing for Syncope

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Abstract

Syncope is transient loss of consciousness. Neurocardiogenic syncope (NCS) is the most common cause of syncope. Head-up tilt-table test (HUTT) has been used to demonstrate physiologic events during graded orthostatic challenge in individuals with significant handicap from NCS. Near-infrared spectroscopy (NIRS) provides a noninvasive, continuous method to monitor trends of regional tissue oxygenation (rSO2). We hypothesize that multisite NIRS monitoring will show differential desaturation patterns in the brain and renal vascular beds during postural stresses. All patients age 7–21 years old scheduled to undergo HUTT were recruited. Two probes for NIRS monitoring were placed on the forehead and above the left paravertebral level at the T10 to L1 space. These leads were attached to the Somanetics monitor (Somanetics, Troy MI). Tissue saturations (rSO2) obtained at two sites were recorded at rest, during the test, and throughout a 5-min recovery period. All data routinely obtained in HUTT were included in the research study database. Thirteen patients were recruited. The average age was 12.9 years. Five patients had a positive tilt-table test. The patients with syncope had rSO2 trends distinctly different from the normal subjects. In these patients, cerebral rSO2 showed a sudden decreasing trend from hypoperfusion, soon followed by various clinical symptoms. The cerebral rSO2 trend, which showed a dramatic increase, was paralleled by renal rSO2. These rSO2 trends were progressive until the patient was brought back to the supine position, which resulted in the rSO2 in both beds returning to baseline. Multisite NIRS-guided HUTT shows differential trends in the different vascular beds during postural gravitational stresses, and these patterns underlie the systemic oxygen consumption to flow-coupling dynamics observed during syncope.

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Acknowledgments

We acknowledge the invaluable logistical support and coordination of this research provided by Mary M. Krolikowski. We also thank Aniko Szabo and Scott Jackson or statistical analysis. Grant support was received from a Pilot Innovative Research Award and from Children’s Research Institute and Children’s Health System, Milwaukee, WI.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Cardiology and Critical Care, Medical College of Wisconsin, Milwaukee, WI, 53226, USA

    Rohit P. Rao

  2. Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA

    Peter C. Frommelt, Stuart Berger & Steven D. Zangwill

  3. Herma Heart Center, Children’s Hospital of Wisconsin, Milwaukee, WI, 53226, USA

    Michael J. Danduran & Jennifer E. Dixon

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  1. Rohit P. Rao
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  2. Michael J. Danduran
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  3. Jennifer E. Dixon
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  4. Peter C. Frommelt
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Correspondence to Rohit P. Rao.

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Rao, R.P., Danduran, M.J., Dixon, J.E. et al. Near Infrared Spectroscopy: Guided Tilt Table Testing for Syncope. Pediatr Cardiol 31, 674–679 (2010). https://doi.org/10.1007/s00246-010-9683-z

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  • DOI: https://doi.org/10.1007/s00246-010-9683-z

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