title: Orthostatic decrease in cardiac chaos during the head-up tilt test in patients with vasovagal syncope.
abstract: BACKGROUND
  Autonomic dysfunction contributes to orthostatic intolerance in vasovagal syncope (VVS), but as it has not been identified by spectral analysis of heart rate variability (HRV) in previous studies, the present hypothesis was that nonlinear analysis of HRV would identify the orthostatic intolerance in VVS.
  
  
  RESULTS
  Twenty-six patients with VVS and 14 matched controls were subjected to 80-degree head-up tilt test (positive: 13 patients; negative: 13 patients and 14 controls). There were no differences in the orthostatic changes in the indices of spectral analyses of HRV among the 3 groups. The Lyapunov exponent (LE) was calculated from 200 consecutive RR-intervals to investigate chaotic behavior, and cardiac chaos was defined as the incidence of the presence of a positive finite LE. Orthostatic decreases in cardiac chaos were observed in the VVS patients (both the positive and negative groups), although there was no orthostatic decrease in the control group (ANOVA: p = 0.008). The receiver-operator characteristic curve indicated that cardiac chaos during the tilt identified VVS regardless of the results of the tilt (p < 0.001, sensitivity: 85.7%, specificity: 96.2%).
  
  
  CONCLUSIONS
  The decrease in cardiac chaos during the tilt test was specific to patients with VVS, even if their response to the test was negative.
authors.affiliation: Department of Emergency Medicine, School of Medicine, Keio University, Tokyo, Japan. suzuki@sc.itc.keio.ac.jp
authors.forename: Masaru
authors.initials: M
authors.lastname: Suzuki
authors.forename: Shingo
authors.initials: S
authors.lastname: Hori
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tomita
authors.forename: Naoki
authors.initials: N
authors.lastname: Aikawa
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D016022:Case-Control Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D019462:Syncope, Vasovagal / Q000503:physiopathology*; D018667:Tilt-Table Test