The Comparative Usefulness of Orthostatic Testing and Tilt Table Testing in the Evaluation of Autonomic-Associated Dizziness

Faraji, Farhoud; Kinsella, Laurence J.; Rutledge, Joseph C.; Mikulec, Anthony A.

doi:10.1097/mao.0b013e3182117769

Cited by 17 publications

(12 citation statements)

References 23 publications

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“…[2] It has already been shown that standing for 3 minutes correlates poorly with a full 30-minute tilt for both change in heart rate and blood pressure. [5;10] We aimed to carry out this analysis to a full 30 minutes of tilt and standing for change in heart rate given the recent description of “delayed POTS.”[12]…”

Section: Discussionmentioning

confidence: 99%

Diagnosing postural tachycardia syndrome: comparison of tilt testing compared with standing haemodynamics

et al. 2012

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Postural tachycardia syndrome (POTS) is characterized by increased heart rate (ΔHR) of ≥30 bpm with symptoms related to upright posture. Active stand (STAND) and passive head-up tilt (TILT) produce different physiological responses. We hypothesized these different responses would affect the ability of individuals to achieve the POTS HR increase criterion. Patients with POTS (n=15) and healthy controls (n=15) underwent 30 min of TILT and STAND testing. ΔHR values were analyzed at 5 min intervals. Receiver Operating Characteristics analysis was performed to determine optimal cut point values of ΔHR for both TILT and STAND. TILT produced larger ΔHR than STAND for all 5 min intervals from 5 min (38±3 bpm vs. 33±3 bpm; P=0.03) to 30 min (51±3 bpm vs. 38±3 bpm; P<0.001). Sensitivity (Sn) of the 30 bpm criterion was similar for all tests (TILT-10=93%, STAND-10=87%, TILT30=100%, and STAND30=93%). Specificity (Sp) of the 30 bpm criterion was less at both 10 and 30 min for TILT (TILT10=40%, TILT30=20%) than STAND (STAND10=67%, STAND30=53%). The optimal ΔHR to discriminate POTS at 10 min were 38 bpm (TILT) and 29 bpm (STAND), and at 30 min were 47 bpm (TILT) and 34 bpm (STAND). Orthostatic tachycardia was greater for TILT (with lower specificity for POTS diagnosis) than STAND at 10 and 30 min. The 30 bpm ΔHR criterion is not suitable for 30 min TILT. Diagnosis of POTS should consider orthostatic intolerance criteria and not be based solely on orthostatic tachycardia regardless of test used.

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Section: Discussionmentioning

confidence: 99%

Diagnosing postural tachycardia syndrome: comparison of tilt testing compared with standing haemodynamics

et al. 2012

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“…Autonomic challenges usually consist of physical stimuli or actions that elicit changes in sympathetic and parasympathetic activity, often reflected as blood pressure and heart rate alterations. While certain tests are impractical inside an MRI environment (such as orthostatic changes elicited either by a tilt table or by changing posture from sitting to standing: Faraji et al, 2011 ; Saal et al, 2015 ), the majority of procedures involving a static body position with minimal electrical equipment are feasible (Adkisson and Benditt, 2015 ). The Valsalva maneuver can be performed in the supine position, with plastic tubing connected to a pressure sensor outside the scanner room and some form of signal/cue to indicate to the participant when to blow into the tube, and when sufficient pressure is reached.…”

Section: Functional Mri Methodologymentioning

confidence: 99%

Functional Imaging of Autonomic Regulation: Methods and Key Findings

et al. 2016

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Central nervous system processing of autonomic function involves a network of regions throughout the brain which can be visualized and measured with neuroimaging techniques, notably functional magnetic resonance imaging (fMRI). The development of fMRI procedures has both confirmed and extended earlier findings from animal models, and human stroke and lesion studies. Assessments with fMRI can elucidate interactions between different central sites in regulating normal autonomic patterning, and demonstrate how disturbed systems can interact to produce aberrant regulation during autonomic challenges. Understanding autonomic dysfunction in various illnesses reveals mechanisms that potentially lead to interventions in the impairments. The objectives here are to: (1) describe the fMRI neuroimaging methodology for assessment of autonomic neural control, (2) outline the widespread, lateralized distribution of function in autonomic sites in the normal brain which includes structures from the neocortex through the medulla and cerebellum, (3) illustrate the importance of the time course of neural changes when coordinating responses, and how those patterns are impacted in conditions of sleep-disordered breathing, and (4) highlight opportunities for future research studies with emerging methodologies. Methodological considerations specific to autonomic testing include timing of challenges relative to the underlying fMRI signal, spatial resolution sufficient to identify autonomic brainstem nuclei, blood pressure, and blood oxygenation influences on the fMRI signal, and the sustained timing, often measured in minutes of challenge periods and recovery. Key findings include the lateralized nature of autonomic organization, which is reminiscent of asymmetric motor, sensory, and language pathways. Testing brain function during autonomic challenges demonstrate closely-integrated timing of responses in connected brain areas during autonomic challenges, and the involvement with brain regions mediating postural and motoric actions, including respiration, and cardiac output. The study of pathological processes associated with autonomic disruption shows susceptibilities of different brain structures to altered timing of neural function, notably in sleep disordered breathing, such as obstructive sleep apnea and congenital central hypoventilation syndrome. The cerebellum, in particular, serves coordination roles for vestibular stimuli and blood pressure changes, and shows both injury and substantially altered timing of responses to pressor challenges in sleep-disordered breathing conditions. The insights into central autonomic processing provided by neuroimaging have assisted understanding of such regulation, and may lead to new treatment options for conditions with disrupted autonomic function.

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“…Only two studies in the literature have compared AST and HUT as a method in the same sample of patients. 19 , 32 Although Faraji et al obtained twofold higher OH prevalance during HUT than AST, the retrospective nature of the study, the lack of methods following one after another (AST and HUT), and extending HUT to the 40th minute may lead to different outcomes. 32 Cooke et al retrospectively evaluated the cases between the age of 22 and 93 years, 19 whereas in the present study, only older adults were included and revealed two different prevalances by two different methods in the same sample of patients.…”

Section: Discussionmentioning

confidence: 99%

Which is preferable for orthostatic hypotension diagnosis in older adults: active standing test or head-up tilt table test?

Aydın

Soysal

Işık

2017

CIA

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Background: Correct evaluation of orthostatic hypotension (OH) is crucial in geriatric practice, since OH is associated with mortality and morbidity. The study aimed to determine the most appropriate method for measuring blood pressure in transition from supine to upright position in order to diagnose OH in older adults. Methods: Active standing test (AST) and head-up tilt table (HUT) test as well as comprehensive geriatric assessment (CGA), including mini-mental state examination or the cognitive state test, mini-nutritional assessment, basic and instrumental activities of daily living, and Tinetti performance-oriented mobility assessment indexes, were performed in 290 geriatric patients. Results: The prevalence of OH during HUT and AST was 19% and 37%, respectively. In patients with OH during HUT, the frequency of dementia and recurrent falls were higher (P,0.05); on the other hand, the levels of serum vitamin D and albumin and estimated glomerular filtration rate were lower (P,0.05). However, all these parameters for OH during AST were not significant (P.0.05). Comparison of the groups according to CGA measurements revealed significant differences in terms of cognition, nutritional status, activities of daily life, and balance function in patients with OH only during HUT (P,0.05), but not during AST (P.0.05). The sensitivity, specificity, positive predictive value, and negative predictive values of AST were 49.0%, 65.5%, 25.0%, and 84.6% respectively, according to HUT. Conclusion:The results suggest that orthostatic blood pressure changes determined by HUT might be of higher clinical significance than that by AST in older adults. It might be important that the evaluation of OH by HUT should be included in daily geriatric practice.

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The Comparative Usefulness of Orthostatic Testing and Tilt Table Testing in the Evaluation of Autonomic-Associated Dizziness

Cited by 17 publications

References 23 publications

Diagnosing postural tachycardia syndrome: comparison of tilt testing compared with standing haemodynamics

Diagnosing postural tachycardia syndrome: comparison of tilt testing compared with standing haemodynamics

Functional Imaging of Autonomic Regulation: Methods and Key Findings

Which is preferable for orthostatic hypotension diagnosis in older adults: active standing test or head-up tilt table test?

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