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Cited by 23Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlLong-Term Effects of COVID-19

Altered oscillatory cerebral blood flow velocity and autoregulation in postural tachycardia syndrome

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Medow, Marvin S., Del Pozzi, Andrew T., Messer, Zachary R., Terilli, Courtney, Stewart, Julian M.·2014·Frontiers in Physiology
DOI 10.3389/fphys.2014.00234PMC PMC4067089
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Abstract

Decreased upright cerebral blood flow (CBF) with hyperpnea and hypocapnia is seen in a minority of patients with postural tachycardia syndrome (POTS). More often, CBF is not decreased despite upright neurocognitive dysfunction. This may result from time-dependent changes in CBF. We hypothesized that increased oscillations in CBF occurs in POTS (N = 12) compared to healthy controls (N = 9), and tested by measuring CBF velocity (CBFv) by transcranial Doppler ultrasound of the middle cerebral artery, mean arterial pressure (MAP) and related parameters, supine and during 70° upright tilt. Autospectra for mean CBFv and MAP, and transfer function analysis were obtained over the frequency range of 0.0078-0.4 Hz. Upright HR was increased in POTS (125 ± 8 vs. 86 ± 2 bpm), as was diastolic BP (74 ± 3 vs. 65 ± 3 mmHg) compared to control, while peripheral resistance, cardiac output, and mean CBFv increased similarly with tilt. Upright BP variability (BPV), low frequency (LF) power (0.04-0.13 Hz), and peak frequency of BPV were increased in POTS (24.3 ± 4.1, and 18.4 ± 4.1 mmHg(2)/Hz at 0.091 Hz vs. 11.8 ± 3.3, and 8.8 ± 2 mmHg(2)/Hz c at 0.071 Hz), as was upright overall CBFv variability, low frequency power and peak frequency of CBFv variability (29.3 ± 4.7, and 22.1 ± 2.7 [cm/s](2)/Hz at.092 Hz vs. 14.7 ± 2.6, and 6.7 ± 1.2 [cm/s](2)/Hz at 0.077Hz). Autospectra were sharply peaked in POTS. LF phase was decreased in POTS (-14 ± 4 vs. -25 ± 10 degrees) while upright. LF gain was increased (1.51 ± 0.09 vs. 0.86 ± 0.12 [cm/s]/ mmHg) while coherence was increased (0.96 ± 0.01 vs. 0.80 ± 0.04). Increased oscillatory BP in upright POTS patients is closely coupled to oscillatory CBFv over a narrow bandwidth corresponding to the Mayer wave frequency. Therefore combined increased oscillatory BP and increased LF gain markedly increases CBFv oscillations in a narrow bandwidth. This close coupling of CBF to MAP indicates impaired cerebral autoregulation that may underlie upright neurocognitive dysfunction in POTS.

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  • Other studies found excessive reductions in middle cerebral artery blood velocity during head-up tilt in POTS, possibly due to sympathetic or hypocapnic cerebral vasoconstriction.

    “Others have shown excessive reductions in middle cerebral artery blood velocity measured by transcranial Doppler in POTS during HUTT, perhaps related to sympathetic-or hypocapnic-mediated cerebral vasoconstriction (Ocon et al., 2009;Medow et al., 2014;Del Pozzi et al., 2014;Jordan et al., 1998).”

    From Postural tachycardia syndrome – Diagnosis, physiology, and prognosis (2018) · cites this paper as Medow et al., 2014

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Authors
Medow, M. S., Del Pozzi, A. T., Messer, Z. R., Terilli, C., & Stewart, J. M.
Affiliations
New York Medical College (US)
Corresponding author
Stewart, Julian M.
ORCID
Venue
Frontiers in Physiology
Publisher
Frontiers Media SA
Published
2014-06-23
Volume
5
Pages
234-234
ISSN
1664-042X (ISSN-L)
DOI
10.3389/fphys.2014.00234
PMC
PMC4067089
OpenAlex
W2082288981
Cited by
23
References
64
Citations by year
2025: 3 · 2024: 2 · 2022: 2 · 2021: 4 · 2020: 3 · 2019: 1 · 2018: 3 · 2017: 1 · 2016: 2 · 2015: 1 · 2014: 1
FWCI
1.65
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Frontiers in Physiology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Touro Scholar (Touro College) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
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, autoregulation, blood pressure variability, middle cerebral artery, tilt table test, transfer function analysis, neurocognitive impairment, orthostatic intolerance, autonomic dysfunction, middle cerebral artery pulsatility index, middle cerebral artery resistance index, middle cerebral artery blood flow velocity

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