Blunted cerebral blood flow velocity in response to a nitric oxide donor in postural tachycardia syndrome
Open accessAbstract
Cognitive deficits are characteristic of postural tachycardia syndrome (POTS). Intact nitrergic nitric oxide (NO) is important to cerebral blood flow (CBF) regulation, neurovascular coupling, and cognitive efficacy. POTS patients often experience defective NO-mediated vasodilation caused by oxidative stress. We have previously shown dilation of the middle cerebral artery in response to a bolus administration of the NO donor sodium nitroprusside (SNP) in healthy volunteers. In the present study, we hypothesized a blunted middle cerebral artery response to SNP in POTS. We used combined transcranial Doppler-ultrasound to measure CBF velocity and near-infrared spectroscopy to measure cerebral hemoglobin oxygenation while subjects were in the supine position. The responses of 17 POTS patients were compared with 12 healthy control subjects (age: 14–28 yr). CBF velocity in POTS patients and control subjects were not different at baseline (75 ± 3 vs. 71 ± 2 cm/s, P = 0.31) and decreased to a lesser degree with SNP in POTS patients (to 71 ± 3 vs. 62 ± 2 cm/s, P = 0.02). Changes in total and oxygenated hemoglobin (8.83 ± 0.45 and 8.13 ± 0.48 μmol/kg tissue) were markedly reduced in POTS patients compared with control subjects (14.2 ± 1.4 and 13.6 ± 1.6 μmol/kg tissue), primarily due to increased venous efflux. The data indicate reduced cerebral oxygenation, blunting of cerebral arterial vasodilation, and heightened cerebral venodilation. We conclude, based on the present study outcomes, that decreased bioavailability of NO is apparent in the vascular beds, resulting in a downregulation of NO receptor sites, ultimately leading to blunted responses to exogenous NO.
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POTS patients have significantly greater decreases in thoracic and cerebral blood flow when compared to healthy controls during tilt.
“Other studies have also demonstrated that POTS patients have significantly greater decreases in thoracic and cerebral blood flow when compared to healthy controls during tilt (21, 23, 25-27).”
From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [25]
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- Authors
- Del Pozzi, A. T., Pandey, A., Medow, M. S., Messer, Z. R., & Stewart, J. M.
- Affiliations
- Departments of Pediatrics and Physiology, New York Medical College, Center for Hypotension, Hawthorne, New York
- New York Medical College (US)
- Corresponding author
- Stewart, Julian M.
- Venue
- American Journal of Physiology-Heart and Circulatory Physiology
- Publisher
- American Physiological Society
- Published
- 2014-08-01
- Volume
- 307
- Issue
- 3
- Pages
- H397-H404
- ISSN
- 0363-6135 (ISSN-L)
- 1522-1539
- PMC
- PMC4121649
- OpenAlex
- W2119384266
- Cited by
- 17
- References
- 64
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2021: 3 · 2020: 2 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 2 · 2015: 1 · 2014: 2
- FWCI
- 1.98
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Physiology-Heart and Circulatory Physiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Touro Scholar (Touro College) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL112736, R01HL074873)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- postural orthostatic tachycardia syndrome, cerebral blood flow velocity, nitric oxide, sodium nitroprusside, neurovascular coupling, NO bioavailability, cognitive impairment, oxidative stress
- MeSH terms
- Adolescent, Adult, Blood Flow Velocity, Blood Pressure, Cerebral Veins, Cerebrovascular Circulation, Female, Humans, Male, Nitric Oxide, Nitroprusside, Oxyhemoglobins, Time Factors, Vasodilation, Vasodilator Agents, Biomarkers, Case-Control Studies, Supine Position, Ultrasonography, Doppler, Transcranial, Spectroscopy, Near-Infrared, Nitric Oxide Donors, Middle Cerebral Artery, Postural Orthostatic Tachycardia Syndrome, Young Adult
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