Hostname: page-component-76fb5796d-2lccl Total loading time: 0 Render date: 2024-04-27T01:32:51.730Z Has data issue: false hasContentIssue false
  • English
  • Français

A Pilot Study using the Compensatory Reserve Index to evaluate individuals with Postural Orthostatic Tachycardia syndrome

Published online by Cambridge University Press:  30 September 2020

Niti Shahi Open the ORCID record for Niti Shahi [Opens in a new window] ,
Gabrielle Shirek ,
Kaci Pickett ,
Alexandra Schwartz ,
Jamie Shoop ,
Ryan Phillips ,
Rachel Workman ,
David Kaplan ,
Clio Pitula  and
Steven Moulton
Niti Shahi*
Affiliation:
Division of Paediatric Surgery, Children’s Hospital Colorado, Aurora, CO, USA Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA Department of Surgery, University of Massachusetts, Worcester, MA, USA
Gabrielle Shirek
Affiliation:
Division of Paediatric Surgery, Children’s Hospital Colorado, Aurora, CO, USA
Kaci Pickett
Affiliation:
The Center for Research in Outcomes for Children’s Surgery, University of Colorado School of Medicine, Aurora, CO, USA
Alexandra Schwartz
Affiliation:
Analytics Resource Center, Children’s Hospital Colorado, Aurora, CO, USA
Jamie Shoop
Affiliation:
UPMC Children’s Hospital of Pittsburgh, Transplant Surgery, Pittsburgh, PA, USA
Ryan Phillips
Affiliation:
Division of Paediatric Surgery, Children’s Hospital Colorado, Aurora, CO, USA Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
Rachel Workman
Affiliation:
Department of Paediatrics, University of Colorado School of Medicine, Aurora, Co, USA
David Kaplan
Affiliation:
Department of Paediatrics, University of Colorado School of Medicine, Aurora, Co, USA
Clio Pitula
Affiliation:
Department of Paediatrics, University of Colorado School of Medicine, Aurora, Co, USA
Steven Moulton
Affiliation:
Division of Paediatric Surgery, Children’s Hospital Colorado, Aurora, CO, USA Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
*
Author for correspondence: Niti Shahi, MD, Department of Surgery, University of Massachusetts School of Medicine, 55 Lake Avenue North, Worcester, MA01655, USA. Fax: (844)-804-3061. E-mail: niti.shahi@umassmemorial.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Purpose:

The diagnosis of Postural Orthostatic Tachycardia syndrome traditionally involves orthostatic vitals evaluation. The Compensatory Reserve Index is a non-invasive, FDA-cleared algorithm that analyses photoplethysmogram waveforms in real time to trend subtle waveform features associated with varying degrees of central volume loss, from normovolemia to decompensation. We hypothesised that patients who met physiologic criteria for Postural Orthostatic Tachycardia syndrome would have greater changes in Compensatory Reserve Index with orthostatic vitals.

Methods:

Orthostatic vitals and Compensatory Reserve Index values were assessed in individuals previously diagnosed with Postural Orthostatic Tachycardia syndrome and healthy controls aged 12–21 years. Adolescents were grouped for comparison based on whether they met heart rate criteria for Postural Orthostatic Tachycardia syndrome (physiologic Postural Orthostatic Tachycardia syndrome).

Results:

Sixty-one patients were included. Eighteen percent of patients with an existing Postural Orthostatic Tachycardia syndrome diagnosis met heart rate criteria, and these patients had significantly greater supine to standing change in Compensatory Reserve Index (0.67 vs. 0.51; p<0.001). The optimal change in Compensatory Reserve Index for physiologic Postural Orthostatic Tachycardia syndrome was 0.60. Patients with physiologic Postural Orthostatic Tachycardia syndrome were more likely to report previous diagnoses of anxiety or depression (p = 0.054, 0.042).

Conclusion:

An accurate diagnosis of Postural Orthostatic Tachycardia syndrome may be confounded by related comorbidities. Only 18% (8/44) of previously diagnosed Postural Orthostatic Tachycardia syndrome patients met heart rate criteria. Findings support the utility of objective physiologic measures, such as the Compensatory Reserve Index, to more accurately identify patients with true autonomic dysfunction.

Keywords

DysautonomiaPostural Orthostatic Tachycardia syndromeadolescentCompensatory Reserve Indexheart rate
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 12 , December 2020 , pp. 1833 - 1839
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Co-senior authors

References

Grigoriou, E, Boris, JR, Dormans, JP. Postural orthostatic tachycardia syndrome (POTS): association with Ehlers-Danlos syndrome and orthopaedic considerations. Clin Orthop Relat Res 2015; 473: 722–728.10.1007/s11999-014-3898-xCrossRefGoogle ScholarPubMed
Boris, JR, Bernadzikowski, T. Demographics of a large paediatric postural orthostatic tachycardia syndrome program. Cardiol Young 2018; 28: 668–674.10.1017/S1047951117002888CrossRefGoogle ScholarPubMed
Boris, JR, Huang, J, Bernadzikowski, T. Orthostatic heart rate does not predict symptomatic burden in pediatric patients with chronic orthostatic intolerance. Clin Auton Res 2020; 30: 19–28.10.1007/s10286-019-00622-yCrossRefGoogle Scholar
Johnson, JN, Mack, KJ, Kuntz, NL, Brands, CK, Porter, CJ, Fischer, PR. Postural orthostatic tachycardia syndrome: a clinical review. Pediatr Neurol 2010; 42: 77–85.CrossRefGoogle ScholarPubMed
Kizilbash, SJ, Ahrens, SP, Bruce, BK, et al. Adolescent fatigue, POTS, and recovery: a guide for clinicians. Curr Prob Pediatr Ad 2014; 44: 108–133.Google ScholarPubMed
Plash, WB, Diedrich, A, Biaggioni, I, et al. Diagnosing postural tachycardia syndrome: comparison of tilt testing compared with standing haemodynamics. Clin Sci (Lond) 2013; 124: 109–114.10.1042/CS20120276CrossRefGoogle ScholarPubMed
Barnhill, KM. POTS and Other Acquired Dysautonomia in Children and Adolescents: Diagnosis, Interventions, and Multi-disciplinary Management. Jessica Kingsley Publishers, 2016.Google Scholar
Convertino, VA, Ryan, KL, Rickards, CA, et al. Physiological and medical monitoring for en route care of combat casualties. J Trauma Acute Care Surg 2008; 64: S342–S353.10.1097/TA.0b013e31816c82f4CrossRefGoogle ScholarPubMed
McGrath, SP, Ryan, KL, Wendelken, SM, Rickards, CA, Convertino, VA. Pulse oximeter plethysmographic waveform changes in awake, spontaneously breathing, hypovolemic volunteers. Anesth Analg 2011; 112: 368–374.CrossRefGoogle ScholarPubMed
Convertino, VA, Moulton, SL, Grudic, GZ, et al. Use of advanced machine-learning techniques for noninvasive monitoring of hemorrhage. J Trauma 2011; 71 (1 Suppl): S25–S32.CrossRefGoogle ScholarPubMed
Brasel, KJ, Guse, C, Gentilello, LM, Nirula, R. Heart rate: is it truly a vital sign? J Trauma 2007; 62: 812–817.10.1097/TA.0b013e31803245a1CrossRefGoogle ScholarPubMed
Ryan, KL, Batchinsky, A, McManus, JG, Rickards, CA, Convertino, VA. Changes in Pulse Character and Mental Status Are Late Responses to Central Hypovolemia. Prehosp Emerg Care 2008; 12: 192–198.10.1080/10903120801907562CrossRefGoogle ScholarPubMed
Convertino, VA, Grudic, G, Mulligan, J, Moulton, S. Estimation of individual-specific progression to impending cardiovascular instability using arterial waveforms. J Appl Physiol 2013; 115: 1196–1202.CrossRefGoogle ScholarPubMed
Moulton, SL, Mulligan, J, Grudic, GZ, Convertino, VA. Running on empty? The compensatory reserve index. J Trauma Acute Care Surg 2013; 75: 1053–1059.10.1097/TA.0b013e3182aa811aCrossRefGoogle ScholarPubMed
Convertino, VA, Howard, JT, Hinojosa-Laborde, C, et al. Individual-Specific, Beat-to-beat Trending of Significant Human Blood Loss: The Compensatory Reserve. Shock 2015; 44 (Suppl 1): 27–32.10.1097/SHK.0000000000000323CrossRefGoogle ScholarPubMed
Benov, A, Yaslowitz, O, Hakim, T, et al. The effect of blood transfusion on compensatory reserve: A prospective clinical trial. J Trauma Acute Care Surg 2017; 83: S71–S76.CrossRefGoogle ScholarPubMed
Convertino, VA, Wirt, MD, Glenn, JF, Lein, BC. The Compensatory Reserve For Early and Accurate Prediction Of Hemodynamic Compromise: A Review of the Underlying Physiology. Shock 2016; 45: 580–590.CrossRefGoogle ScholarPubMed
Stewart, CL, Mulligan, J, Grudic, GZ, Convertino, VA, Moulton, SL. Detection of low-volume blood loss: compensatory reserve versus traditional vital signs. J Trauma Acute Care Surg 2014; 77: 892–898; discussion 892–989.10.1097/TA.0000000000000423CrossRefGoogle ScholarPubMed
Benrud-Larson, LM, Dewar, MS, Sandroni, P, Rummans, TA, Haythornthwaite, JA, Low, PA. Quality of life in patients with postural tachycardia syndrome. Mayo Clinic Proceedings; Elsevier, 2002.10.4065/77.6.531CrossRefGoogle Scholar
Anderson, JW, Lambert, EA, Sari, CI, et al. Cognitive function, health-related quality of life, and symptoms of depression and anxiety sensitivity are impaired in patients with the postural orthostatic tachycardia syndrome (POTS). Front Physiol 2014; 5: 230.CrossRefGoogle Scholar
Raj, V, Haman, KL, Raj, SR, et al. Psychiatric profile and attention deficits in postural tachycardia syndrome. J Neurol Neurosurg Psychiatry 2009; 80: 339–344.CrossRefGoogle ScholarPubMed
Palermo, TM, Putnam, J, Armstrong, G, Daily, S. Adolescent autonomy and family functioning are associated with headache-related disability. Clin J Pain 2007; 23: 458–465.CrossRefGoogle ScholarPubMed
Oppliger, RA, Magnes, SA, Popowski, LA, Gisolfi, CV. Accuracy of urine specific gravity and osmolality as indicators of hydration status. Int J Sport Nutr Exerc Metab 2005; 15: 236–251.10.1123/ijsnem.15.3.236CrossRefGoogle ScholarPubMed
Singer, W, Sletten, DM, Opfer-Gehrking, TL, Brands, CK, Fischer, PR, Low, PA. Postural tachycardia in children and adolescents: what is abnormal? J Pediatr 2012; 160: 222–226.CrossRefGoogle ScholarPubMed
Skinner, JE, Driscoll, SW, Porter, CJ, et al. Orthostatic heart rate and blood pressure in adolescents: reference ranges. J Child Neurol 2010; 25: 1210–1215.CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377–381.10.1016/j.jbi.2008.08.010CrossRefGoogle ScholarPubMed
Boris, JR, Bernadzikowski, T. Utilisation of medications to reduce symptoms in children with postural orthostatic tachycardia syndrome. Cardiol Young 2018; 28: 1386–1392.CrossRefGoogle ScholarPubMed
Piqueras, JA, Martín-Vivar, M, Sandin, B, San Luis, C, Pineda, D. The Revised Child Anxiety and Depression Scale: a systematic review and reliability generalization meta-analysis. J Affect Disord 2017; 218: 153–169.10.1016/j.jad.2017.04.022CrossRefGoogle ScholarPubMed
McKenzie, K, Murray, A, Freeston, M, Whelan, K, Rodgers, J. Validation of the Revised Children’s Anxiety and Depression Scales (RCADS) and RCADS short forms adapted for adults. J Affect Disord 2019; 245: 200–204.CrossRefGoogle ScholarPubMed
Walker, LS, Greene, JW. The functional disability inventory: measuring a neglected dimension of child health status. J Pediatr Psychol 1991; 16: 39–58.CrossRefGoogle ScholarPubMed
Byles, J, Byrne, C, Boyle, MH, Offord, DR. Ontario Child Health Study: reliability and validity of the general functioning subscale of the McMaster Family Assessment Device. Fam Process 1988; 27: 97–104.10.1111/j.1545-5300.1988.00097.xCrossRefGoogle ScholarPubMed
Anttila, P, Sourander, A, Metsähonkala, L, Aromaa, M, Helenius, H, Sillanpää, M. Psychiatric symptoms in children with primary headache. J American Acad Child Psy 2004; 43: 412–419.10.1097/00004583-200404000-00007CrossRefGoogle ScholarPubMed
Epstein, NB, Bishop, DS, Levin, S. The McMaster model of family functioning. J Marital Fam Ther 1978; 4: 19–31.CrossRefGoogle Scholar
Miller, IW, Epstein, NB, Bishop, DS, Keitner, GI. The McMaster family assessment device: reliability and validity. J Marital Fam Ther 1985; 11: 345–356.CrossRefGoogle Scholar
Li, H, Liao, Y, Wang, Y, et al. Baroreflex sensitivity predicts short-term outcome of postural tachycardia syndrome in children. PloS One 2016; 11: e0167525.10.1371/journal.pone.0167525CrossRefGoogle ScholarPubMed
Gagnon, D, Schlader, ZJ, Adams, A, et al. The Effect of Passive Heat Stress and Exercise-Induced Dehydration on the Compensatory Reserve During Simulated Hemorrhage. Shock 2016; 46 (3 Suppl 1): 74–82.10.1097/SHK.0000000000000653CrossRefGoogle ScholarPubMed
Ross, AJ, Medow, MS, Rowe, PC, Stewart, JM. What is brain fog? An evaluation of the symptom in postural tachycardia syndrome. Clin Auton Res 2013; 23: 305–311.10.1007/s10286-013-0212-zCrossRefGoogle ScholarPubMed
Sheldon, RS, Grubb, BP, 2nd, Olshansky, B, et al. 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope. Heart Rhythm 2015; 12: e41–e63.CrossRefGoogle ScholarPubMed
Benrud-Larson, LM, Sandroni, P, Haythornthwaite, JA, Rummans, TA, Low, PA. Correlates of functional disability in patients with postural tachycardia syndrome: preliminary cross-sectional findings. Health Psychol 2003; 22: 643.CrossRefGoogle ScholarPubMed