Resting heart rate variability as a diagnostic marker of cardiovascular dysautonomia in postural tachycardia syndrome

Ganagarajan Inbaraj; Kaviraja Udupa; Prathyusha P. Vasuki; Atchayaram Nalini; Talakad N. Sathyaprabha

doi:10.1515/jbcpp-2022-0069

Article

Resting heart rate variability as a diagnostic marker of cardiovascular dysautonomia in postural tachycardia syndrome

Ganagarajan Inbaraj , Kaviraja Udupa , Prathyusha P. Vasuki , Atchayaram Nalini and Talakad N. Sathyaprabha

Published/Copyright: November 11, 2022

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From the journal Journal of Basic and Clinical Physiology and Pharmacology Volume 34 Issue 1

Abstract

Objectives

Postural orthostatic tachycardia syndrome (POTS) is a disorder of the autonomic nervous system characterised by orthostatic intolerance and orthostatic tachycardia without hypotension. Heart rate variability (HRV) is the most reliable and objective tool for assessing autonomic dysfunction severity. In the present study, we aimed to investigate HRV changes in resting supine position, predicting severity and cardiovascular risk in patients with POTS.

Methods

We compared 100 POTS patients with 160 healthy controls matched for age and gender in a case-control design. Along with clinical characterization, heart rate variability was evaluated using ambulatory 5 min ECG in lead II and expressed in frequency and time-domain measures.

Results

The resting heart rate of patients with POTS was significantly higher than that of healthy controls. In HRV measures, root mean square successive difference of RR intervals (RMSSD), total and high frequency (HF) powers were statistically lower with an increased low frequency (LF) to high-frequency ratio in patients with POTS compared to healthy controls. Further, stepwise logistic regression analysis showed increased basal HR and LF/HF as significant predictors of POTS and its severity.

Conclusions

This is the first study on a large cohort of patients with POTS from India wherein HRV was assessed. The study showed reduced parasympathetic activity and increased sympathetic activity in patients with POTS compared to healthy controls. These findings of increased resting heart rate and LF/HF were found to be potential predictors of POTS and future cardiovascular risks, which need to be replicated in a larger and more homogenized cohort.

Keywords: autonomic function; heart rate variability; POTS; sympathovagal balance; time and frequency domain measures

Corresponding author: Dr. Kaviraja Udupa, Additional Professor, Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560 029, India, Phone: 91 80 26995914, Mobile: 91 9844497111, E-mail: kaviudupa@gmail.com

Ganagarajan Inbaraj and Kaviraja Udupa contributed equally and considered as co-first authors.

Acknowledgements

Authors would like to acknowledge the support of our laboratory members Krishna Prasad, K Srikanth in data collection efforts.

Author contributions: KU, GI, STN, AN: Conceptualization and design of the study. GI, KP, NS, KU: Carried out the study and analyzed the data. GI, PV: Statistical analysis. KU, GI: wrote the initial draft. KU, STN, AN: Edited and finalized the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: This study was part of ongoing project titled ‘Exploring the differential effects of heart rate variability measures in various neuropsychiatric disorders with orthostatic intolerance’ and obtained Institute Ethics approval.

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Received: 2022-03-08

Accepted: 2022-10-17

Published Online: 2022-11-11

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DOI: doi.org/10.1515/jbcpp-2022-0069

Keywords for this article

autonomic function; heart rate variability; POTS; sympathovagal balance; time and frequency domain measures