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Cited by 128Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlVestibular and auditory disorders

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

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Plash, Walker B., Diedrich, André, Biaggioni, Italo, Garland, Emily M., Paranjape, Sachin Y., Black, Bonnie K., Dupont, William D., Raj, Satish R.·2013·Clinical Science
DOI 10.1042/cs20120276PMC PMC3478101
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Abstract

POTS (postural tachycardia syndrome) is characterized by an increased heart rate (ΔHR) of ≥30 bpm (beats/min) 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 analysed at 5 min intervals. ROC (receiver operating characteristic) 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 compared with 33±3 bpm; P=0.03) to 30 min (51±3 bpm compared with 38±3 bpm; P<0.001). Sn (sensitivity) of the 30 bpm criterion was similar for all tests (TILT10=93%, STAND10=87%, TILT30=100%, and STAND30=93%). Sp (specificity) 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 Sp 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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  • When the 10-min criterion for upright position was applied to these data, HUT and the active stand test were comparable.

    “When the 10-min criterion for upright position was applied to these data, HUT and the active stand test were comparable (95).”

    From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [95]

    The Results section, “Diagnostic Characteristics of the 30 bpm Criterion” (page unavailable), reports comparable sensitivity at 10 minutes: 93% for tilt and 87% for standing. But specificity was substantially lower for tilt (40% versus 67%), so the tests were not comparable on both diagnostic measures under that criterion. (LLM, conf=0.88)

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  • The 10-minute standing tests for POTS provided reasonable accuracy in a small adult study, but have not been validated for pediatric populations.

    “The 10-minute standing tests for POTS provided reasonable accuracy in a small study on adults, but these tests have not been validated for pediatric populations.143”

    From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [143]

  • The tilt table test leads to a slightly greater increase in heart rate than the stand test, which increases its diagnostic sensitivity.

    “The tilt table test leads to a slightly greater increase in heart rate than the stand test,39 which increases its diagnostic sensitivity.”

    From Diagnosis and management of postural orthostatic tachycardia syndrome (2022) · cites this paper as [39]

  • When the active stand test was compared with passive HUT, orthostatic tachycardia was noted to be greater with HUT than with the active stand test in both POTS patients and healthy controls.

    “When the active stand test was compared with passive HUT, orthostatic tachycardia was noted to be greater with HUT than with the active stand test in both POTS patients and healthy controls.”

    From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [95]

  • The orthostatic tachycardia of POTS is greater with head-up tilt than with active standing during prolonged tests, but comparable between the two for the 10-minute period used for diagnosis.

    “Accordingly, the orthostatic tachycardia is greater with the HUT test in both patients with POTS and control subjects with prolonged tests, but the orthostatic tachycardia is comparable between HUT and active stand for the 10 minutes used for the POTS criterion [17].”

    From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [17]

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Authors
Plash, W. B., Diedrich, A., Biaggioni, I., Garland, E. M., Paranjape, S. Y., Black, B. K., Dupont, W. D., & Raj, S. R.
Affiliations
Vanderbilt University (US)
Corresponding author
Biaggioni, Italo
ORCID
Venue
Clinical Science
Publisher
Portland Press Ltd.
Published
2012-09-26
Volume
124
Issue
2
Pages
109-114
ISSN
  • 0143-5221 (ISSN-L)
  • 1470-8736
DOI
10.1042/cs20120276
PMC
PMC3478101
OpenAlex
W2034752202
Cited by
128
References
27
Citations by year
2026: 6 · 2025: 17 · 2024: 16 · 2023: 13 · 2022: 10 · 2021: 9 · 2020: 12 · 2019: 8 · 2018: 8 · 2017: 7 · 2016: 5 · 2015: 8 · 2014: 3 · 2013: 4 · 2012: 2
FWCI
5.54
Type
journal article
Language
en
Open access
Locations
  • Clinical Science (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Vanderbilt University
  • National Institutes of Health (UL1TR000445)
  • National Heart, Lung, and Blood Institute (R01HL071784, P01HL056693, R01HL102387, P01 HL-56693)
  • National Institute of Neurological Disorders and Stroke (U54NS065736, R01NS055670)
  • National Center for Research Resources (KL2RR024977, TL1RR024978, UL1RR024975)
  • NIH Clinical Center
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
Keywords
postural orthostatic tachycardia syndrome, tilt table test, orthostatic tachycardia, sensitivity and specificity, orthostatic intolerance, diagnostic thresholds, hemodynamics
MeSH terms
Adult, Female, Heart Rate, Humans, Male, Middle Aged, Posture, Retrospective Studies, ROC Curve, Sensitivity and Specificity, Tennessee, Time Factors, Tilt-Table Test, Postural Orthostatic Tachycardia Syndrome

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