Juraschek Stephen P, Ojo Noelle, Monroe Janet, Strom Jordan B, Stout Jessica, Manning Warren J, Turkson-Ocran Ruth-Alma N, Kolaci Gabrielle, Geier Kaitlynn, Baptista Carla, Picanzo Araina, Mukamal Kenneth J, Matos Jason D
Division of General Medicine, Section for Research, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, CO-1309, #217, Boston, MA, 02215, USA.
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Echo Res Pract. 2025 May 20;12(1):12. doi: 10.1186/s44156-025-00075-2.
Orthostatic hypotension (OH) is associated with cardiovascular disease, particularly among older adults. While a standing transthoracic echocardiogram (TTE) could theoretically identify changes in cardiac output to diagnose cardiogenic OH, there are no established protocols for orthostatic TTEs and their feasibility is unknown.
We recruited 115 patients scheduled for elective outpatient TTE. Consenting participants, who were able to stand safely, underwent their scheduled recumbent TTE, followed by a standing TTE, performed within 1-2 minutes of standing. The focused TTE used the apical window to measure velocity time integral across the aortic valve to assess cardiac output. Blood pressure (BP) was measured in the supine and standing positions and patients were asked about symptoms of dizziness and lightheadedness. OH was defined as a change in standing minus supine systolic BP ≤-20 mm Hg or in diastolic BP of ≤-10 mm Hg. Of the 115 enrolled participants, 102 (89%) completed the standing echocardiogram protocol. Among those completing, mean age was 63.4 (SD, 14.8) years (38% were ≥ 70 years), 48% women, and 34% had a BMI ≥ 30 kg/m. There were 21% with OH. Upon standing, systolic BP changed by -5.9 mm Hg (95% CI: -9.5, -2.2), diastolic BP by 2.4 mm Hg (-0.1, 4.8), and cardiac output by -0.4 L/min (95% CI: -0.7, -0.1). Change in cardiac output (per 1 L/min) was associated with a higher odds of systolic OH (OR: 1.60; 95% CI: 1.05, 2.42), but not diastolic OH (OR: 1.21; 95% CI: 0.63, 2.32).
Standing TTE is safe, well-tolerated, and feasible in the ambulatory setting. Moreover, TTE changes in cardiac output are associated with systolic OH. This clinical assessment shows promise for distinguishing OH etiologies and could inform further research on treatments to prevent OH.
体位性低血压（OH）与心血管疾病相关，在老年人中尤为常见。虽然站立位经胸超声心动图（TTE）理论上可以识别心输出量的变化以诊断心源性OH，但目前尚无既定的体位性TTE检查方案，其可行性也未知。
我们招募了115名计划进行择期门诊TTE检查的患者。同意参与且能够安全站立的受试者先进行预定的卧位TTE检查，然后在站立1 - 2分钟内进行站立位TTE检查。重点TTE检查使用心尖窗测量主动脉瓣血流速度时间积分以评估心输出量。测量仰卧位和站立位的血压，并询问患者是否有头晕和头重脚轻的症状。OH定义为站立位收缩压减去仰卧位收缩压变化≤ -20 mmHg或舒张压变化≤ -10 mmHg。在115名登记的参与者中，102名（89%）完成了站立位超声心动图检查方案。在完成检查的参与者中，平均年龄为63.4（标准差，14.8）岁（38%年龄≥70岁），48%为女性，34%的体重指数（BMI）≥30 kg/m²。有21%的人患有OH。站立后，收缩压变化为 -5.9 mmHg（95%置信区间：-9.5，-2.2），舒张压变化为2.4 mmHg（-0.1，4.8），心输出量变化为 -0.4 L/min（95%置信区间：-0.7，-0.1）。心输出量变化（每1 L/min）与收缩期OH的较高几率相关（比值比：1.60；95%置信区间：1.05，2.42），但与舒张期OH无关（比值比：1.21；95%置信区间：0.63，2.32）。
站立位TTE在门诊环境中是安全的、耐受性良好且可行的。此外，TTE检查中心输出量的变化与收缩期OH相关。这种临床评估对于区分OH病因具有前景，并可为预防OH的治疗进一步研究提供参考。
