Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Auton Neurosci. 2021 Nov;235:102836. doi: 10.1016/j.autneu.2021.102836. Epub 2021 Jun 30.
The National Institutes of Health hosted a workshop in 2019 to build consensus around the current state of understanding of the pathophysiology of postural orthostatic tachycardia syndrome (POTS) and to identify knowledge gaps that must be addressed to enhance clinical care of POTS patients through research. This second (of two) articles summarizes current knowledge gaps, and outlines the clinical and research priorities for POTS. POTS is a complex, multi-system, chronic disorder of the autonomic nervous system characterized by orthostatic intolerance and orthostatic tachycardia without hypotension. Patients often experience a host of other related disabling symptoms. The functional and economic impacts of this disorder are significant. The pathophysiology remains incompletely understood. Beyond the significant gaps in understanding the disorder itself, there is a paucity of evidence to guide treatment which can contribute to suboptimal care for this patient population. The vast majority of physicians have minimal to no familiarity or training in the assessment and management of POTS. Funding for POTS research remains very low relative to the size of the patient population and impact of the syndrome. In addition to efforts to improve awareness and physician education, an investment in research infrastructure including the development of standardized disease-specific evaluation tools and outcome measures is needed to facilitate effective collaborative research. A national POTS research consortium could facilitate well-controlled multidisciplinary clinical research studies and therapeutic trials. These priorities will require a substantial increase in the number of research investigators and the amount of research funding in this area.
美国国立卫生研究院于 2019 年举办了一次研讨会,旨在就直立位心动过速综合征(POTS)的病理生理学当前理解状态达成共识,并确定必须解决的知识空白,以通过研究加强对 POTS 患者的临床护理。这是(两部分中的)第二部分文章,总结了当前的知识差距,并概述了 POTS 的临床和研究重点。POTS 是一种复杂的、多系统的自主神经系统慢性疾病,其特征是直立不耐受和直立性心动过速而没有低血压。患者通常会出现一系列其他相关的致残症状。这种疾病的功能和经济影响是显著的。其病理生理学仍不完全清楚。除了对疾病本身的理解存在重大差距外,缺乏证据来指导治疗,这可能导致对该患者群体的治疗效果不佳。绝大多数医生对 POTS 的评估和管理都非常不熟悉或没有接受过相关培训。与患者群体的规模和综合征的影响相比,POTS 研究的资金仍然非常少。除了努力提高认识和医生教育外,还需要投资于研究基础设施,包括开发标准化的特定疾病评估工具和结果衡量标准,以促进有效的合作研究。一个全国性的 POTS 研究联盟可以促进良好控制的多学科临床研究和治疗试验。这些重点需要在该领域增加大量的研究人员和研究资金。
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