一项使用代偿储备指数评估体位性直立性心动过速综合征患者的试点研究。

A Pilot Study using the Compensatory Reserve Index to evaluate individuals with Postural Orthostatic Tachycardia syndrome.

作者信息

Shahi Niti, Shirek Gabrielle, Pickett Kaci, Schwartz Alexandra, Shoop Jamie, Phillips Ryan, Workman Rachel, Kaplan David, Pitula Clio, Moulton Steven

机构信息

Division of Paediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA.

Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.

出版信息

Cardiol Young. 2020 Dec;30(12):1833-1839. doi: 10.1017/S1047951120002905. Epub 2020 Sep 30.

DOI:10.1017/S1047951120002905

PMID:32993834

Abstract

PURPOSE

The diagnosis of Postural Orthostatic Tachycardia syndrome traditionally involves orthostatic vitals evaluation. The Compensatory Reserve Index is a non-invasive, FDA-cleared algorithm that analyses photoplethysmogram waveforms in real time to trend subtle waveform features associated with varying degrees of central volume loss, from normovolemia to decompensation. We hypothesised that patients who met physiologic criteria for Postural Orthostatic Tachycardia syndrome would have greater changes in Compensatory Reserve Index with orthostatic vitals.

METHODS

Orthostatic vitals and Compensatory Reserve Index values were assessed in individuals previously diagnosed with Postural Orthostatic Tachycardia syndrome and healthy controls aged 12-21 years. Adolescents were grouped for comparison based on whether they met heart rate criteria for Postural Orthostatic Tachycardia syndrome (physiologic Postural Orthostatic Tachycardia syndrome).

RESULTS

Sixty-one patients were included. Eighteen percent of patients with an existing Postural Orthostatic Tachycardia syndrome diagnosis met heart rate criteria, and these patients had significantly greater supine to standing change in Compensatory Reserve Index (0.67 vs. 0.51; p<0.001). The optimal change in Compensatory Reserve Index for physiologic Postural Orthostatic Tachycardia syndrome was 0.60. Patients with physiologic Postural Orthostatic Tachycardia syndrome were more likely to report previous diagnoses of anxiety or depression (p = 0.054, 0.042).

CONCLUSION

An accurate diagnosis of Postural Orthostatic Tachycardia syndrome may be confounded by related comorbidities. Only 18% (8/44) of previously diagnosed Postural Orthostatic Tachycardia syndrome patients met heart rate criteria. Findings support the utility of objective physiologic measures, such as the Compensatory Reserve Index, to more accurately identify patients with true autonomic dysfunction.

摘要

目的

传统上，体位性直立性心动过速综合征的诊断涉及直立位生命体征评估。代偿储备指数是一种经美国食品药品监督管理局（FDA）批准的非侵入性算法，可实时分析光电容积脉搏波描记图波形，以追踪与从血容量正常到失代偿的不同程度中心血容量丢失相关的细微波形特征。我们假设，符合体位性直立性心动过速综合征生理标准的患者，其代偿储备指数随直立位生命体征的变化会更大。

方法

对先前诊断为体位性直立性心动过速综合征的个体以及12至21岁的健康对照者进行直立位生命体征和代偿储备指数值评估。根据青少年是否符合体位性直立性心动过速综合征的心率标准（生理性体位性直立性心动过速综合征）进行分组比较。

结果

共纳入61例患者。已有体位性直立性心动过速综合征诊断的患者中，18%符合心率标准，这些患者仰卧位到站立位时代偿储备指数的变化显著更大（0.67对0.51；p<0.001）。生理性体位性直立性心动过速综合征代偿储备指数的最佳变化值为0.60。生理性体位性直立性心动过速综合征患者更有可能报告先前有焦虑或抑郁诊断（p = 0.054，0.042）。