Low Body Mass Index Is Associated with a Positive Response during a Head‐Up Tilt Test

Leiria, Tiago Luiz Luz; Barcellos, Sônia Regina; Moraes, Maria Antonieta; Lima, Gustavo Glotz de; Kús, Teresa; J, Barbisan

doi:10.1111/pace.12006

Cited by 8 publications

(5 citation statements)

References 35 publications

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“…In obesity, chronic caloric surplus raises sympathetic activity and blood pressure [14] while improving orthostatic tolerance [24]. Chronic caloric deficiency elicits the opposite response in individuals with low body mass index and in patients with anorexia nervosa [17,23]. A few days of caloric restriction are sufficient in reducing sympathetic outflow and orthostatic tolerance in both obese and lean individuals [2,12].…”

Section: Introductionmentioning

confidence: 99%

Effects of short-term hypercaloric nutrition on orthostatic tolerance in healthy individuals: a randomized controlled crossover study

et al. 2022

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Reduced-caloric intake lowers blood pressure through sympathetic inhibition, and worsens orthostatic tolerance within days. Conversely, hypercaloric nutrition augments sympathetic activity and blood pressure. Because dietary interventions could be applied in patients with syncope, we tested the hypothesis that short-term hypercaloric dieting improves orthostatic tolerance. In a randomized crossover trial, 20 healthy individuals (7 women, 26.7 ± 8 years, 22.6 ± 2 kg/m2) followed a 4-day hypercaloric (25% increase of energy intake by fat) or normocaloric nutritional plan, with a washout period of at least 23 days between interventions. We then performed head-up tilt table testing with incremental lower body negative pressure while recording beat-by-beat blood pressure and heart rate. The primary endpoint was orthostatic tolerance defined as time to presyncope. Time to presyncope during combined head-up tilt and lower body negative pressure did not differ between hypercaloric and normocaloric dieting (median 23.19 versus 23.04 min, ratio of median 1.01, 95% CI of ratio 0.5–1.9). Heart rate, blood pressure, heart rate variability, and blood pressure variability in the supine position and during orthostatic testing did not differ between interventions. We conclude that 4 days of moderate hypercaloric nutrition does not significantly improve orthostatic tolerance in healthy individuals. Nevertheless, given the important interaction between energy balance and cardiovascular autonomic control in the brain, caloric intake deserves more attention as a potential contributor and treatment target for orthostatic intolerance.

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Section: Introductionmentioning

confidence: 99%

Effects of short-term hypercaloric nutrition on orthostatic tolerance in healthy individuals: a randomized controlled crossover study

et al. 2022

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“…The patients in this study had a history of syncope and a lower BMI compared to the healthy group, and both groups were within normal weight ranges. Greater incidence of syncope related to lower BMI has been reported; Luis Luz Leira et al (15) in a study of 419 patients undergoing head-up tilt test for syncope investigation reported a higher incidence of a positive test in those with BMI values < 18.5 kg/m2 (p=0.01). Other studies indicate that body weight influences the response to orthostatism, which could be a factor influencing both the history of syncope and the symptomatic response during the test.…”

Section: Discussionmentioning

confidence: 95%

Decreased cerebral blood flow in a supine position in patients with a history of syncope and presyncope during the Tilt Table Test

Cano,

González-Hermosillo,

Murata

et al. 2024

Preprint

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Objective: To analyze the hemodynamic response, cerebral blood flow, and the sympathovagal balance between patients with structurally healthy hearts who have a history of syncope and presyncope that exhibited signs or symptoms of presyncope without progressing to syncope during the tilt-table test, and a healthy group. Methodology: A retrospective study was conducted on patients attending the dysautonomia clinic of a tertiary care center. Individuals of both sexes aged 15 to 50 years were included. Patients with positive tests for VVS, OH, or POTS, and those with negative results were excluded. As a healthy group, healthy volunteers without a personal history of syncope or presyncope and with a negative tilt-table test were included. Statistical Analysis: Categorical variables were expressed as percentages and quantitative variables as mean ± standard deviation. Repeated measures ANOVA, the χ2 test, and effect size using Glass's Δ were used for group comparisons. A P-value < 0.05 was considered statistically significant. The R software, RStudio, and the effsize package were used for analysis. Results: The main finding was a significant decrease in cerebral blood flow secondary to an increase in cerebral vascular resistance in patients from a supine position at the start and throughout the test, compared to the control group. Conclusion: The analysis of cerebral hemodynamics allows for the identification of a subpopulation of patients who exhibit decreased cerebral blood flow from a supine position during the tilt-table test while maintaining cardiovascular stability without progressing to syncope.

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“…Individuals with lower BMI have greater predisposition to vasovagal syncope and orthostatic hypotension, often accompanied by dysregulated autonomic nervous system activity. 26–28 …”

Section: Discussionmentioning

confidence: 99%

“…Individuals with lower BMI have greater predisposition to vasovagal syncope and orthostatic hypotension, often accompanied by dysregulated autonomic nervous system activity. [26][27][28] LVEF is a valuable indicator for the diagnosis and monitoring of heart conditions such as heart failure and cardiomyopathy. Our findings have demonstrated that LVEF was an independent predictor to discriminate cardiac syncope from non-cardiac syncope.…”

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confidence: 99%

Development and Validation of a Novel Predictive Model for the Early Differentiation of Cardiac and Non-Cardiac Syncope

Wu,

Chen,

Gao

et al. 2024

IJGM

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Background The diagnosis of cardiac syncope remains a challenge. This study sought to develop and validate a diagnostic model for the early identification of individuals likely to have a cardiac cause. Methods 877 syncope patients with a determined cause were retrospectively enrolled at a tertiary heart center. They were randomly divided into the training set and validation set at a 7:3 ratio. We analyzed the demographic information, medical history, laboratory tests, electrocardiogram, and echocardiogram by the least absolute shrinkage and selection operator (LASSO) regression for selection of key features. Then a multivariable logistic regression analysis was performed to identify independent predictors and construct a diagnostic model. The receiver operating characteristic curves, area under the curve (AUC), calibration curves, and decision curve analysis were used to evaluate the predictive accuracy and clinical value of this nomogram. Results Five independent predictors for cardiac syncope were selected: BMI (OR 1.088; 95% CI 1.022–1.158; P =0.008), chest symptoms preceding syncope (OR 5.251; 95% CI 3.326–8.288; P <0.001), logarithmic NT-proBNP (OR 1.463; 95% CI 1.240–1.727; P <0.001), left ventricular ejection fraction (OR 0.940; 95% CI 0.908–0.973; P <0.001), and abnormal electrocardiogram (OR 6.171; 95% CI 3.966–9.600; P <0.001). Subsequently, a nomogram based on a multivariate logistic regression model was developed and validated, yielding AUC of 0.873 (95% CI 0.845–0.902) and 0.856 (95% CI 0.809–0.903), respectively. The calibration curves showcased the nomogram’s reasonable calibration, and the decision curve analysis demonstrated good clinical utility. Conclusion A diagnostic tool providing individualized probability predictions for cardiac syncope was developed and validated, which may potentially serve as an effective tool to facilitate early identification of such patients.

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Low Body Mass Index Is Associated with a Positive Response during a Head‐Up Tilt Test

Abstract: In our sample, changes in BMI are associated with a positive response for HUT, and oral contraceptives seemed to protect against this response. Further studies are needed with larger numbers of patients to corroborate this finding.

Cited by 8 publications

References 35 publications

Effects of short-term hypercaloric nutrition on orthostatic tolerance in healthy individuals: a randomized controlled crossover study

Effects of short-term hypercaloric nutrition on orthostatic tolerance in healthy individuals: a randomized controlled crossover study

Decreased cerebral blood flow in a supine position in patients with a history of syncope and presyncope during the Tilt Table Test

Development and Validation of a Novel Predictive Model for the Early Differentiation of Cardiac and Non-Cardiac Syncope

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