The utility of Valsalva maneuver in the diagnoses of orthostatic disorders.
The objective of this study was to assess hemodynamic responses and baroreflex sensitivity (BRS) indexes during Valsalva maneuver (VM) and head-up tilt (HUT) testing in orthostatic intolerance (OI). Patients with neurogenic orthostatic hypotension (NOH, n = 26), postural tachycardia syndrome (n = 26) and symptomatic OI (n = 14) were compared with healthy population (control, n = 107) and inappropriate sinus tachycardia (n = 7). Hemodynamic assessment included patterning and quantification with vagal and adrenergic BRS (BRSa/BRSa1). In NOH, cardiovagal systolic blood pressure (SBP) decrements in VM and HUT were correlated (r = 0.660, P < 0.001); a "V" pattern of VM indicated α-BRSa failure. Yet BRSa1 did not reveal changes vs. control (P > 0.05) or was not applicable in 60% of NOH. In symptomatic OI, compared with control, cardiovagal SBP decrements were larger (P < 0.05); higher BRSa1 contradicted higher adrenergic index (Composite Autonomic Severity Score). Overshoot in phase IV dipped below baseline or dropped ≥ 10 mmHg over 8 s in postural tachycardia syndrome ("N" pattern), but by 3 s in inappropriate sinus tachycardia ("M" pattern). Visualization of distinct VM patterns allows primary evaluation of autonomic dysfunction and differentiation of the various forms of OI. BRSa1 evaluation is compromised by pathological SBP patterns. VM patterning is a valuable nonpostural supplement to HUT capable of detecting and differentiating OI.
Department of Clinical Neurological Sciences, University Hospital, London Health Sciences Centre, London, Ontario, Canada; and Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
Iryna S
IS
Palamarchuk
Department of Clinical Neurological Sciences, University Hospital, London Health Sciences Centre, London, Ontario, Canada; and.
Jacquie
J
Baker
Department of Clinical Neurological Sciences, University Hospital, London Health Sciences Centre, London, Ontario, Canada; and Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada kkimpin@uwo.ca.
Kurt
K
Kimpinski
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017704:Baroreflex; D001794:Blood Pressure; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D054972:Postural Orthostatic Tachycardia Syndrome / Q000175:diagnosis* / Q000503:physiopathology; D011187:Posture; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013564:Sympathetic Nervous System / Q000503:physiopathology; D013616:Tachycardia, Sinus / Q000175:diagnosis* / Q000503:physiopathology; D018667:Tilt-Table Test; D013997:Time Factors; D014630:Vagus Nerve / Q000503:physiopathology; D014636:Valsalva Maneuver; D055815:Young Adult
Valsalva maneuver; adrenergic indices; hemodynamic patterns; orthostatic intolerance