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Spectral and cross-spectral autoregressive analysis of cardiovascular variables in subjects with different degrees of orthostatic tolerance

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Abstract

The mechanisms leading to vasovagal syncope are still unclear. A simple discriminating test for the identification of syncopeprone subjects is not presently available. Fifty-two subjects had a stepwise orthostatic test with 60o tilt and −20 and −40 mm Hg lower-body negative pressure before the appearance of impending syncope symptoms. Spectral and cross-spectral analyses of heart period and systolic pressure time series were performed to estimate the power of the high-frequency (≈0.25 Hz) and low-frequency (≈0.1 Hz) oscillations, the coherence between heart period and systolic pressure, and the mean low-frequency and high-frequency central frequency, phase shift, and transfer function at maximal coherence. According to time to presyncope, the 52 subjects were divided into two groups: 25 with normal orthostatic tolerance, and 27 with poor orthostatic tolerance. In the supine positions, the mean central low-frequency was significantly lower in poortolerance group than in normal-tolerance group, discriminating poor from normal orthostatic tolerance with 80% specificity and 83% sensitivity, and was significantly correlated to time to presyncope. In the 2 to 3 minutes preceding syncopem subjects with poor orthostatic tolerance had less tachycardia, lower low-frequency power of systolic pressure, higher respiratory frequency, and a less negative phase shift in high-frequency range. In presyncope, sympathetic activation is reduced in subjects with poor orthostatic tolerance. In addition, the higher breathing frequency and the smaller negativity of phase shift in high-frequency range, which may indicate an inadequate engagement of the baroreflex, suggest a causal role of respiration in the development of syncope. Supine central values of low frequency may be proposed as a valuable clinical index of orthostatic intolerance.

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Authors and Affiliations

  1. Department of Neurological Sciences and Vision, Section of Physiology, University of Verona, Strada Le Grazie, 8, 37134, Verona, Italy

    Giosuè Gulli M.D. & Antonio Cevese M.D.

  2. Institute for Cardiovascular Research, University of Leeds, Leeds, UK

    Victoria L. Wight B.S. & Roger Hainsworth M.D., Ph.D.

Authors
  1. Giosuè Gulli M.D.
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  2. Victoria L. Wight B.S.
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  3. Roger Hainsworth M.D., Ph.D.
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  4. Antonio Cevese M.D.
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Correspondence to Antonio Cevese M.D..

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Gulli, G., Wight, V.L., Hainsworth, R. et al. Spectral and cross-spectral autoregressive analysis of cardiovascular variables in subjects with different degrees of orthostatic tolerance. Clinical Autonomic Research 11, 19–27 (2001). https://doi.org/10.1007/BF02317798

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  • DOI: https://doi.org/10.1007/BF02317798

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