A late phase 2 diastolic blood pressure rise of ≥15 mmHg during the Valsalva maneuver identified hyperadrenergic POTS patients, who exhibited significantly higher peripheral sympathetic neurovascular transduction compared to non-hyperadrenergic patients (2.60 vs 0.58 mmHg/spike·s−1).
Cross-Sectional (n=43)
No
Does the Valsalva phase 2 diastolic blood pressure rise (DBPVM2l_rise) serve as a sympathetic marker to identify hyperadrenergic POTS?
A Valsalva phase 2 diastolic blood pressure rise ≥ 15 mmHg serves as a practical, non-invasive clinical marker to identify hyperadrenergic POTS driven by augmented neurovascular transduction.
Absolute Event Rate: 2.6% vs 0.58%
p-value: p=<0.001
Abstract Purpose Muscle sympathetic nerve activity (MSNA) is valuable for managing postural tachycardia syndrome (POTS), but microneurography is clinically impractical. We investigated whether the Valsalva phase 2 diastolic blood pressure rise (DBP VM2lᵣise) serves as a sympathetic marker and proposed enhanced neurovascular transduction as a pathophysiological mechanism in hyperadrenergic POTS. Methods We included 21 POTS women and 22 healthy women to perform Valsalva and microneurography. MSNA spike rate was obtained using stationary wavelet transformation. The DBP VM2lᵣise cut point for hyperadrenergic POTS was optimized by the golden section search with its correlation to phase 2 MSNA spike rate as an objective function. We defined peripheral sympathetic neurovascular transduction (psNVT) as a ratio of DBP VM2lᵣise to early phase 2 MSNA increase. We compared Valsalva responses between the identified hyperadrenergic and non-hyperadrenergic POTS. Results The DBP VM2lᵣise strongly correlated with the Valsalva phase 2 MSNA spike rate percentage change from baseline in healthy (r = 0. 874, p < 0. 001). The DBP VM2lᵣise cutoff criterion of 15 mmHg optimally separated POTS into 7 hyperadrenergic (≥ 15 mmHg, r = 0. 902, p = 0. 014) and 14 non-hyperadrenergic (< 15 mmHg, r = 0. 629, p = 0. 021). Although similar MSNA spike rate, the hyperadrenergic group had higher baseline systolic blood pressure (118 ± 10 vs 105 ± 12 mmHg, p = 0. 026), shorter pressure recovery time (1. 15 ± 0. 75 vs 2. 59 ± 1. 17 s, p = 0. 048), and higher psNVT (2. 60 ± 1. 02 vs 0. 58 ± 0. 46 mmHg/spike·s −1, p < 0. 001) than the non-hyperadrenergic POTS. Conclusion DBP VM2lᵣise ≥ 15 mmHg could be a sympathetic clinical marker and could identify hyperadrenergic POTS, characterized by enhanced neurovascular transduction despite comparable MSNA levels. This novel pathophysiological insight underscores the importance of sympathetic markers in POTS clinical management.
Kulapatana et al. (Wed,) conducted a cross-sectional in Postural tachycardia syndrome (POTS) (n=43). Late phase 2 diastolic blood pressure rise (DBPVM2l_rise) ≥ 15 mmHg vs. DBPVM2l_rise < 15 mmHg was evaluated on Peripheral sympathetic neurovascular transduction (psNVT) (95% CI 1.155-2.867, p=<0.001). A late phase 2 diastolic blood pressure rise of ≥15 mmHg during the Valsalva maneuver identified hyperadrenergic POTS patients, who exhibited significantly higher peripheral sympathetic neurovascular transduction compared to non-hyperadrenergic patients (2.60 vs 0.58 mmHg/spike·s−1).