Cerebral Perfusion Monitoring Using Near-Infrared Spectroscopy During Head-Up Tilt Table Test in Patients With Orthostatic Intolerance
Cerebral Perfusion Monitoring Using Near-Infrared Spectroscopy During Head-Up Tilt Table Test in Patients With Orthostatic Intolerance
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DOI：
10.3389/fnhum.2019.00055
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发表时间：
2019-02-19
影响因子：
2.9
通讯作者：
Kim, Beop-Min
中科院分区：
文献类型：
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作者：
Kim, Yoo Hwan;Paik, Seung-ho;Kim, Beop-Min
直立倾斜试验（HUT）是评价立位不耐受的主要临床检查方法之一。HUT可分为三个阶段：动态倾斜阶段（仰卧向上倾斜）、静态倾斜阶段（保持倾斜70度）和倾斜后阶段（向下倾斜回到仰卧位）。通常，监测血压（BP）和心率（HR）以观察OI症状，但这是脑灌注的间接测量，可能导致HUT评估不准确。在这项研究中，我们实施了108通道近红外光谱（NIRS）探头，通过监测健康对照（HC）、HUT结果正常的OI患者和HUT结果阳性的OI患者的脑血流动力学变化来表征HUT性能：血管迷走性晕厥（VS）、体位性直立性心动过速综合征（POTS）、直立性低血压（OH）和直立性高血压（OHT）。在静态倾斜阶段结束时，与HC相比，OI患者通常没有完全恢复到基线脑氧合和总血容量。我们通过多项式拟合总血容量变化和确定拐点来表征脑稳态的恢复。与HC组相比，HUT结果正常的OI患者，VS，OH或OHT显示在HUT期间恢复脑稳态延迟。
The head-up tilt table test (HUT) is one of the primary clinical examinations for evaluating orthostatic intolerance (OI). HUT can be divided into three phases: dynamic tilt phase (supine to tilt up), static tilt phase (remain tilted at 70 degrees), and post tilt phase (tilt down back to supine position). Commonly, blood pressure (BP) and heart rate (HR) are monitored to observe for OI symptoms, but are indirect measurements of cerebral perfusion and can lead to inaccurate HUT evaluation. In this study, we implemented a 108-channel near-infrared spectroscopy (NIRS) probe to characterize HUT performance by monitoring cerebral hemodynamic changes for healthy controls (HCs), OI patients with normal HUT results, and OI patients with positive HUT results: vasovagal syncope (VS), postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension (OH), and orthostatic hypertension (OHT). By the end of the static tilt phase, OI patients typically did not show a complete recovery back to baseline cerebral oxygenation and total blood volume compared to HCs. We characterized the return to cerebral homeostasis by polynomial fitting total blood volume changes and determining the inflection point. The OI patients with normal HUT results, VS, OH, or OHT showed a delay in the return to cerebral homeostasis compared to the HC group during HUT.