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Orthostatic tolerance is difficult to predict in recurrent syncope patients

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Abstract

Objectives

We tested the hypothesis that detailed anthropometric and hemodynamic measurements predict orthostatic tolerance in neurally mediated syncope patients. In addition, we tested whether orthostatic tolerance is related to syncope frequency in real life.

Background

Earlier studies in patients with neurally mediated syncope suggested that orthostatic heart rate and blood pressure responses predict the tilt table responses with high sensitivity and specificity.

Methods

We analyzed data from 157 consecutive patients (n = 100 exploratory cohort, n = 57 confirmatory cohort) with recurrent syncope in whom orthostatic tolerance was quantified as the time to (pre)syncope during head-up tilt testing combined with lower body negative pressure. We measured heart rate, brachial blood pressure, cardiac stroke volume, heart rate and blood pressure variability, and spontaneous baroreflex sensitivity supine and early during head-up tilt.

Results

The orthostatic heart rate increase showed the strongest correlation with orthostatic tolerance. The best multivariate model including age, supine diastolic blood pressure, supine blood pressure variability, as well as tilt-induced changes in diastolic blood pressure and heart rate explained no more that 40% of the variability in orthostatic tolerance. The model failed to predict orthostatic tolerance in the confirmatory cohort. Frequency or number of free-living syncopal episodes were only weakly related to orthostatic tolerance.

Conclusions

In patients with neurally mediated syncope, orthostatic tolerance in the clinical laboratory is difficult to predict with a wide range of anthropometric and cardiovascular measurements and correlates poorly with syncope occurrence in real life.

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Authors and Affiliations

  1. Experimental Clinical Research Center, Max-Delbrueck-Centrum for Molecular Medicine, Medical University Charité, Campus Buch, Lindenberger Weg 80, 13125, Berlin, Germany

    Christoph Schroeder & Friedrich C. Luft

  2. Institute for Clinical Pharmacology, Hannover Medical School, Hannover, Germany

    Jens Tank, Karsten Heusser & Jens Jordan

  3. Health TwiSt GmbH, Berlin, Germany

    Andreas Busjahn

  4. Division of Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Center, Vanderbilt University, Nashville, TN, USA

    André Diedrich

Authors
  1. Christoph Schroeder
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  2. Jens Tank
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  3. Karsten Heusser
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  4. Andreas Busjahn
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  6. Friedrich C. Luft
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  7. Jens Jordan
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Correspondence to Christoph Schroeder.

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Schroeder, C., Tank, J., Heusser, K. et al. Orthostatic tolerance is difficult to predict in recurrent syncope patients. Clin Auton Res 21, 37–45 (2011). https://doi.org/10.1007/s10286-010-0090-6

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  • DOI: https://doi.org/10.1007/s10286-010-0090-6

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