title: Orthostatic Changes in Hemodynamics and Cardiovascular Biomarkers in Dysautonomic Patients.
abstract: BACKGROUND
  Impaired autonomic control of postural homeostasis results in orthostatic intolerance. However, the role of neurohormones in orthostatic intolerance has not been explained.
  
  
  METHODS
  Six-hundred-and-seventy-one patients (299 males; 55 ± 22 years) with unexplained syncope underwent head-up tilt (HUT) with serial blood sampling. Systolic blood pressure (SBP) and heart rate (HR) supine, after 3 min, and lowest BP/highest HR during HUT were recorded. Plasma levels of epinephrine, norepinephrine, renin, C-terminal-pro-arginine-vasopressin (CT-proAVP), C-terminal- endothelin-1 (CT-proET-1), and mid-regional-fragment of pro-atrial-natriuretic-peptide (MR-proANP) were determined at supine and 3 min of HUT. Multivariate-adjusted logistic regression model was applied to compare 1st (reference) with 4th quartile of 3 min and maximal ΔSBP/ΔHR (i.e. pronounced hypotension or tachycardia) vs. changes in neuroendocrine biomarkers, respectively.
  
  
  RESULTS
  Higher resting CT-proET-1 predicted BP fall at 3 min (Odds ratio (OR) per 1 SD: 1.62, 95%CI 1.18-2.22; p = 0.003), and max BP fall during HUT (1.82, 1.28-2.61; p = 0.001). Higher resting CT-proAVP predicted BP fall at 3 min (1.33, 1.03-1.73; p = 0.03), which was also associated with increase in CT-proAVP (1.86, 1.38-2.51; p = 0.00005) and epinephrine (1.47, 1.12-1.92; p = 0.05) during HUT. Lower resting MR-proANP predicted tachycardia at 3 min (0.37, 0.24-0.59; p = 0.00003), and max tachycardia during HUT (0.47, 0.29-0.77; p = 0.002). Further, tachycardia during HUT was associated with increase in epinephrine (1.60, 1.15-2.21; p = 0.005), and norepinephrine (1.87, 1.38-2.53; p = 0.005).
  
  
  CONCLUSIONS
  Resting CT-proET-1 and CT-proAVP are increased in orthostatic hypotension, while resting MR-proANP is decreased in postural tachycardia. Moreover, early BP fall during orthostasis evokes increase in CT-proAVP and epinephrine, while postural tachycardia is associated with increase in norepinephrine and epinephrine.
authors.affiliation: Department of Clinical Sciences, Lund University, Clinical Physiology and Nuclear Medicine Unit, Skåne University Hospital, Malmö, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Nilsson
authors.affiliation: National Heart and Lung Institute, Imperial College, St Mary's Hospital Campus, London, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Sutton
authors.affiliation: Department of Clinical Sciences, Lund University, Hypertension and Cardiovascular Disease Group, Clinical Research Centre, Skåne University Hospital, Malmö, Sweden.
authors.forename: Widet
authors.initials: W
authors.lastname: Tas
authors.affiliation: Department of Clinical Sciences, Lund University, Hypertension and Cardiovascular Disease Group, Clinical Research Centre, Skåne University Hospital, Malmö, Sweden.
authors.forename: Philippe
authors.initials: P
authors.lastname: Burri
authors.affiliation: Department of Clinical Sciences, Lund University, Hypertension and Cardiovascular Disease Group, Clinical Research Centre, Skåne University Hospital, Malmö, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Melander
authors.affiliation: Department of Clinical Sciences, Lund University, Hypertension and Cardiovascular Disease Group, Clinical Research Centre, Skåne University Hospital, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
authors.forename: Artur
authors.initials: A
authors.lastname: Fedorowski
mesh_terms: D015415:Biomarkers / Q000097:blood*; D001794:Blood Pressure; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D007024:Hypotension, Orthostatic / Q000097:blood* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009490:Neurosecretory Systems / Q000503:physiopathology; D016017:Odds Ratio; D054969:Primary Dysautonomias / Q000097:blood* / Q000503:physiopathology*; D012018:Reflex; D012044:Regression Analysis; D013575:Syncope; D013599:Systole; D013610:Tachycardia / Q000097:blood / Q000503:physiopathology; D018667:Tilt-Table Test
chemical_list: D015415:Biomarkers