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Is there a relationship between hypocapnia and tachycardia in postural orthostatic tachycardia syndrome (POTS)? A systematic review

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Data may be made available to other investigators upon reasonable request and following appropriate data sharing agreements.

References

  1. Raj SR, Guzman JC, Harvey P, Richer L, Schondorf R, Seifer C, Thibodeau-Jarry N, Sheldon RS (2020) Canadian cardiovascular society position statement on postural orthostatic tachycardia syndrome (POTS) and related disorders of chronic orthostatic intolerance. Can J Cardiol 36(3):357–372. https://doi.org/10.1016/j.cjca.2019.12.024

    Article  PubMed  Google Scholar 

  2. Stewart JM, Pianosi P, Shaban MA, Terilli C, Svistunova M, Visintainer P, Medow MS (2018) Postural hyperventilation as a cause of postural tachycardia syndrome: increased systemic vascular resistance and decreased cardiac output when upright in all postural tachycardia syndrome variants. J Am Heart Assoc 7(13):e008854. https://doi.org/10.1161/JAHA.118.008854

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Stewart JM, Pianosi P, Shaban MA, Terilli C, Svistunova M, Visintainer P, Medow MS (2018) Hemodynamic characteristics of postural hyperventilation: POTS with hyperventilation versus panic versus voluntary hyperventilation. J Appl Physiol 125(5):1396–1403. https://doi.org/10.1152/japplphysiol.00377.2018

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Del Pozzi AT, Schwartz CE, Tewari D, Medow MS, Stewart JM (2014) Reduced cerebral blood flow with orthostasis precedes hypocapnic hyperpnea, sympathetic activation, and postural tachycardia syndrome. Hypertension 63(6):1302–1308. https://doi.org/10.1161/HYPERTENSIONAHA.113.02824

    Article  CAS  PubMed  Google Scholar 

  5. Novak P (2018) Hypocapnic cerebral hypoperfusion: a biomarker of orthostatic intolerance. PLoS ONE 13(9):e0204419. https://doi.org/10.1371/journal.pone.0204419

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Novak V, Spies JM, Novak P, McPhee BR, Rummans TA, Low PA (1998) Hypocapnia and cerebral hypoperfusion in orthostatic intolerance. Stroke 29(9):1876–1881. https://doi.org/10.1161/01.str.29.9.1876

    Article  CAS  PubMed  Google Scholar 

  7. Burnum JF, Hickam JB, McINTOSH HD (1954) The effect of hypocapnia on arterial blood pressure. Circulation 9(1):89–95. https://doi.org/10.1161/01.cir.9.1.89

    Article  CAS  PubMed  Google Scholar 

  8. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Moher D (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wells GA, Shea B, O’connell D, Peterson J, Welch V, Losos M, Tugwell P (2011) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Hospital Research Institute, Ottawa, p 2011

    Google Scholar 

  10. Stewart JM, Del Pozzi AT, Pandey A, Messer ZR, Terilli C, Medow MS (2015) Oscillatory cerebral blood flow is associated with impaired neurocognition and functional hyperemia in postural tachycardia syndrome during graded tilt. Hypertension 65(3):636–643. https://doi.org/10.1161/HYPERTENSIONAHA.114.04576

    Article  CAS  PubMed  Google Scholar 

  11. Medow MS, Kothari ML, Goetz AM, O’Donnell-Smith MB, Terilli C, Stewart JM (2017) Decreasing cerebral oxygen consumption during upright tilt in vasovagal syncope. Physiol Rep 5(10):13286. https://doi.org/10.14814/phy2.13286

    Article  CAS  Google Scholar 

  12. Taneja I, Medow MS, Clarke DA, Ocon AJ, Stewart JM (2011) Baroreceptor unloading in postural tachycardia syndrome augments peripheral chemoreceptor sensitivity and decreases central chemoreceptor sensitivity. Am J PhysioL Heart Circ Physiol 301(1):H173–H179. https://doi.org/10.1152/ajpheart.01211.2010

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Tani H, Singer W, McPhee BR, Opfer-Gehrking TL, Haruma K, Kajiyama G, Low PA (2000) Splanchnic-mesenteric capacitance bed in the postural tachycardia syndrome (POTS). Autonomic Neuroscie Basic Clin 86(1–2):107–113. https://doi.org/10.1016/S1566-0702(00)00205-8

    Article  CAS  Google Scholar 

  14. Stewart JM, Medow MS, Cherniack NS, Natelson BH (2006) Postural hypocapnic hyperventilation is associated with enhanced peripheral vasoconstriction in postural tachycardia syndrome with normal supine blood flow. A J Physiol. Heart Circ Physiol 291(2):H904–H913. https://doi.org/10.1152/ajpheart.01359.2005

    Article  CAS  Google Scholar 

  15. Van De Borne P, Mezzetti S, Montano N, Narkiewicz K, Degaute JP, Somers VK (2000) Hyperventilation alters arterial baroreflex control of heart rate and muscle sympathetic nerve activity. Am J Physiol Heart Circ Physiol 279(2):H536–H541. https://doi.org/10.1152/ajpheart.2000.279.2.H536

    Article  PubMed  Google Scholar 

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Funding

This work was supported in part by the National Center for Advancing Translational Sciences Award UL1 TR000445 and Standing Up to POTS. S.I.R and J.B. are supported by the Natural Sciences and Engineering Research Council of Canada (NSERC) Brain CREATE Program. S.I.R. is supported by an Alberta Graduate Excellence Scholarship (AGES), Alberta Strategy for Patient Oriented SUPPORT Unit (AbSPORU), and the Libin Cardiovascular Institute. J.B. is supported by a Canadian Institutes of Health Research (CIHR) Fellowship and the Libin Cardiovascular Institute Post-Doctoral Fellowship in Women’s Cardiovascular Health.

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Authors and Affiliations

  1. Department of Cardiac Sciences, University of Calgary, GAC70 HRIC Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada

    Shaun I. Ranada, Lucy Y. Lei, Jacquie Baker, Aaron A. Phillips, Robert S. Sheldon & Satish R. Raj

  2. Department of Physiology and Pharmacology, University of Calgary, Calgary, Canada

    Richard Wilson & Aaron A. Phillips

  3. Libin Cardiovascular Institute, University of Calgary, Calgary, Canada

    Shaun I. Ranada, Lucy Y. Lei, Jacquie Baker, Richard Wilson, Aaron A. Phillips, Robert S. Sheldon & Satish R. Raj

  4. Hotchkiss Brain Institute, University of Calgary, Calgary, Canada

    Jacquie Baker, Richard Wilson & Aaron A. Phillips

  5. Cumming School of Medicine, University of Calgary, Calgary, Canada

    Shaun I. Ranada, Lucy Y. Lei, Jacquie Baker, Richard Wilson, Aaron A. Phillips, Robert S. Sheldon & Satish R. Raj

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  1. Shaun I. Ranada
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  2. Lucy Y. Lei
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  6. Robert S. Sheldon
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  7. Satish R. Raj
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Contributions

All authors have read and approved the final version of this manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All persons designated as authors qualify for authorship, and all those who qualify for authorship are listed.

Corresponding author

Correspondence to Satish R. Raj.

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Conflict of interest

The authors declare that they have no conflict of interest. SIR: none, LYL: none, JB: none, RW: none, AP: is a consultant for and shareholder of ONWARD Medical—a publicly traded company commercializing hemodynamic therapeutics for neurological conditions. Honoraria from AD Instruments. RSS: none. SRR: Served as a consultant for Lundbeck LLC, Theravance Biopharma, and Amneal Pharma related to neurogenic orthostatic hypotension; Consultant to Servier Affaires Medicales, Regeneron, and argenx BV related to postural orthostatic tachycardia syndrome. Honoraria from Spire Learning and Medscape for developing CME materials on neurogenic orthostatic hypotension. DMSB Chair for a Phase 2 study of an irritable bowel syndrome medication for Arena Pharmaceuticals with compensation. Past-President of the American Autonomic Society without financial compensation.

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The manuscript does not contain clinical studies or patient data.

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Ranada, S.I., Lei, L.Y., Baker, J. et al. Is there a relationship between hypocapnia and tachycardia in postural orthostatic tachycardia syndrome (POTS)? A systematic review. Clin Auton Res 33, 191–195 (2023). https://doi.org/10.1007/s10286-023-00928-y

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