Andrew Lee1, Xiao Liu1, Carine Rosenberg1, Sanjana Borle1, Daerin Hwang1, Lan S Chen1, Xiaochun Li2, Noel Bairey Merz3, Peng-Sheng Chen4. 1. Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. 2. Department of Biostatistics and Health Data Science, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, Indiana. 3. Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. 4. Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: chenp@cshs.org.
Abstract
BACKGROUND: Chronic orthostatic intolerance (OI) is characterized by the development of tachycardia and other symptoms when assuming an upright body position. OBJECTIVE: The purpose of this study was to test the hypothesis that skin sympathetic nerve activity (SKNA) bursts are specific symptomatic biomarkers in patients with chronic OI. METHODS: We used an electrocardiogram monitor with a built-in triaxial accelerometer to simultaneously record SKNA and posture in ambulatory participants. Study 1 compared chronic OI (14 women and 2 men; mean age 35 ± 10 years) with reference control participants (14 women; mean age 31 ± 6 years). Study 2 included 17 participants with chronic OI (15 women and 2 men; mean age 39 ± 12 years) not yet treated with ivabradine, pyridostigmine, or β-blockers. RESULTS: In study 1, there were 124 episodes (8 ± 4 per participant) of postural changes, with 11 episodes (8.9%) associated with symptoms. In comparison, 0 of 104 postural changes (7 ± 3 per participant) in controls were symptomatic (P = .0011). In participants with chronic OI, the SKNA bursts associated with symptoms had higher burst frequencies, longer burst durations, and larger mean burst areas than did bursts during asymptomatic periods. However, SKNA bursts and tachycardia were asymptomatic in controls. We analyzed 110 symptomatic episodes in study 2 (6 ± 5 per participant). Among them, 98 (89.1%) followed at least 1 SKNA burst. In comparison, only 41 (37.3%) had heart rate exceed 100 beats/min 1 minute before symptom onset (P < .0001). CONCLUSION: SKNA bursts are a highly specific, albeit insensitive, symptomatic biomarker for chronic OI.
BACKGROUND: Chronic orthostatic intolerance (OI) is characterized by the development of tachycardia and other symptoms when assuming an upright body position. OBJECTIVE: The purpose of this study was to test the hypothesis that skin sympathetic nerve activity (SKNA) bursts are specific symptomatic biomarkers in patients with chronic OI. METHODS: We used an electrocardiogram monitor with a built-in triaxial accelerometer to simultaneously record SKNA and posture in ambulatory participants. Study 1 compared chronic OI (14 women and 2 men; mean age 35 ± 10 years) with reference control participants (14 women; mean age 31 ± 6 years). Study 2 included 17 participants with chronic OI (15 women and 2 men; mean age 39 ± 12 years) not yet treated with ivabradine, pyridostigmine, or β-blockers. RESULTS: In study 1, there were 124 episodes (8 ± 4 per participant) of postural changes, with 11 episodes (8.9%) associated with symptoms. In comparison, 0 of 104 postural changes (7 ± 3 per participant) in controls were symptomatic (P = .0011). In participants with chronic OI, the SKNA bursts associated with symptoms had higher burst frequencies, longer burst durations, and larger mean burst areas than did bursts during asymptomatic periods. However, SKNA bursts and tachycardia were asymptomatic in controls. We analyzed 110 symptomatic episodes in study 2 (6 ± 5 per participant). Among them, 98 (89.1%) followed at least 1 SKNA burst. In comparison, only 41 (37.3%) had heart rate exceed 100 beats/min 1 minute before symptom onset (P < .0001). CONCLUSION: SKNA bursts are a highly specific, albeit insensitive, symptomatic biomarker for chronic OI.
Authors: Andrew P Owens; David A Low; Valeria Iodice; Hugo D Critchley; Christopher J Mathias Journal: Auton Neurosci Date: 2016-10-19 Impact factor: 3.145
Authors: Anisiia Doytchinova; Jonathan L Hassel; Yuan Yuan; Hongbo Lin; Dechun Yin; David Adams; Susan Straka; Keith Wright; Kimberly Smith; David Wagner; Changyu Shen; Vicenta Salanova; Chad Meshberger; Lan S Chen; John C Kincaid; Arthur C Coffey; Gang Wu; Yan Li; Richard J Kovacs; Thomas H Everett; Ronald Victor; Yong-Mei Cha; Shien-Fong Lin; Peng-Sheng Chen Journal: Heart Rhythm Date: 2016-09-23 Impact factor: 6.343
Authors: Satish R Raj; Juan C Guzman; Paula Harvey; Lawrence Richer; Ronald Schondorf; Colette Seifer; Nicolas Thibodeau-Jarry; Robert S Sheldon Journal: Can J Cardiol Date: 2020-03 Impact factor: 5.223
Authors: Ritsuko Kohno; David S Cannom; Brian Olshansky; Shijun Cindy Xi; Darshan Krishnappa; Wayne O Adkisson; Faye L Norby; Artur Fedorowski; David G Benditt Journal: J Am Heart Assoc Date: 2021-08-16 Impact factor: 5.501
Authors: Satish R Raj; Kate M Bourne; Lauren E Stiles; Mitchell G Miglis; Melissa M Cortez; Amanda J Miller; Roy Freeman; Italo Biaggioni; Peter C Rowe; Robert S Sheldon; Cyndya A Shibao; Andre Diedrich; David M Systrom; Glen A Cook; Taylor A Doherty; Hasan I Abdallah; Blair P Grubb; Artur Fedorowski; Julian M Stewart; Amy C Arnold; Laura A Pace; Jonas Axelsson; Jeffrey R Boris; Jeffrey P Moak; Brent P Goodman; Kamal R Chémali; Tae H Chung; David S Goldstein; Anil Darbari; Steven Vernino Journal: Auton Neurosci Date: 2021-06-30 Impact factor: 2.355