Cardiac Origins of the Postural Orthostatic Tachycardia Syndrome
Cardiac Origins of the Postural Orthostatic Tachycardia Syndrome
复制标题
DOI：
10.1016/j.jacc.2010.02.043
复制
发表时间：
2010-06-22
影响因子：
24
通讯作者：
Levine, Benjamin D.
中科院分区：
文献类型：
--
作者：
Fu, Qi;VanGundy, Tiffany B.;Levine, Benjamin D.
目的本研究的目的是检验假设，一个小的心脏加上减少血容量有助于体位性直立性心动过速综合征（POTS），运动训练改善这种syndrome.Background POTS患者有显着增加，在直立性心率。然而，其潜在的机制是未知的，有效的治疗是不确定的。方法27例POTS患者进行了自主神经功能测试，心脏磁共振成像，血容量测量。其中25名患者参加了为期3个月的专门设计的运动训练计划，其中19名完成了该计划，这些患者在训练后进行了重新评估，并与16名健康对照者进行了比较。结果与对照组相比，患者的直立心率和总外周阻力增加，而每搏输出量和心输出量减少。两组之间的压力反射功能相似。左心室质量（中位数[第25、75次/分位数]，1.26 g/kg [1.12、1.37 g/kg]对比1.45 g/kg [1.34、1.57 g/kg]; p < 0.01）和血容量（60 ml/kg [54，64 ml/kg] vs. 71 ml/kg [65，78 ml/kg]; p < 0.01），患者组小于对照组。运动训练使左心室质量和血容量分别增加约12%和约7%，直立心率降低9次/min [1，17次/min]。19例患者中有10例在训练后不再符合POTS标准，而患者的生活质量由36项简表健康调查评估在所有患者训练后均得到改善。直立时明显的心动过速是由于心脏小，加上血容量减少。在大多数患者中，运动训练改善甚至治愈了这种综合征。根据其潜在的病理生理学，给POTS起一个新名字似乎是合理的，“格林奇综合征”，因为在苏斯博士的这本著名的儿童读物中，主角的心脏“小了两个尺寸”。（J Am科尔心脏病学杂志2010; 55：2858-68）（C）2010年美国心脏病学会基金会
Objectives The purpose of this study was to test the hypothesis that a small heart coupled with reduced blood volume contributes to the postural orthostatic tachycardia syndrome (POTS) and that exercise training improves this syndrome.Background Patients with POTS have marked increases in heart rate during orthostasis. However, the underlying mechanisms are unknown and the effective therapy is uncertain.Methods Twenty-seven POTS patients underwent autonomic function tests, cardiac magnetic resonance imaging, and blood volume measurements. Twenty-five of them participated in a 3-month specially designed exercise training program with 19 completing the program; these patients were re-evaluated after training.Results were compared with those of 16 healthy controls. Results Upright heart rate and total peripheral resistance were greater, whereas stroke volume and cardiac output were smaller in patients than in controls. Baroreflex function was similar between groups. Left ventricular mass (median [25th, 75th percentiles], 1.26 g/kg [1.12, 1.37 g/kg] vs. 1.45 g/kg [1.34, 1.57 g/kg]; p < 0.01) and blood volume (60 ml/kg [54, 64 ml/kg] vs. 71 ml/kg [65, 78 ml/kg]; p < 0.01) were smaller in patients than in controls. Exercise training increased left ventricular mass and blood volume by approximately 12% and approximately 7% and decreased upright heart rate by 9 beats/min [1, 17 beats/min]. Ten of 19 patients no longer met POTS criteria after training, whereas patient quality of life assessed by the 36-item Short-Form Health Survey was improved in all patients after training.Conclusions Autonomic function was intact in POTS patients. The marked tachycardia during orthostasis was attributable to a small heart coupled with reduced blood volume. Exercise training improved or even cured this syndrome in most patients. It seems reasonable to offer POTS a new name based on its underlying pathophysiology, the "Grinch syndrome," because in this famous children's book by Dr. Seuss, the main character had a heart that was "two sizes too small." (J Am Coll Cardiol 2010; 55: 2858-68) (C) 2010 by the American College of Cardiology Foundation