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Medicine

اختبار الخيمة مع الجمع بين خفض ضغط الجسم السلبية: أ "المعيار الذهبي" لقياس التسامح الانتصابي

Published: March 21, 2013
doi:
10.3791/4315
, , ,
1Department of Biomedical Physiology and Kinesiology,Simon Fraser University

Summary

نحن تصف "المعيار الذهبي" لتقييم التسامح الانتصابي (OT) باستخدام اختبار الخيمة مع الضغط السفلي من الجسم مجتمعة السلبية (LBNP). ويمكن الجمع بين هذا مع المنظمات غير الغازية التقييمات السيطرة منعكس القلب والأوعية الدموية. يتم تعريف الاستجابات العادية وغير العادية.

Abstract

Orthostatic tolerance (OT) refers to the ability to maintain cardiovascular stability when upright, against the hydrostatic effects of gravity, and hence to maintain cerebral perfusion and prevent syncope (fainting). Various techniques are available to assess OT and the effects of gravitational stress upon the circulation, typically by reproducing a presyncopal event (near-fainting episode) in a controlled laboratory environment. The time and/or degree of stress required to provoke this response provides the measure of OT. Any technique used to determine OT should: enable distinction between patients with orthostatic intolerance (of various causes) and asymptomatic control subjects; be highly reproducible, enabling evaluation of therapeutic interventions; avoid invasive procedures, which are known to impair OT1.

In the late 1980s head-upright tilt testing was first utilized for diagnosing syncope2. Since then it has been used to assess OT in patients with syncope of unknown cause, as well as in healthy subjects to study postural cardiovascular reflexes2-6. Tilting protocols comprise three categories: passive tilt; passive tilt accompanied by pharmacological provocation; and passive tilt with combined lower body negative pressure (LBNP). However, the effects of tilt testing (and other orthostatic stress testing modalities) are often poorly reproducible, with low sensitivity and specificity to diagnose orthostatic intolerance7.

Typically, a passive tilt includes 20-60 min of orthostatic stress continued until the onset of presyncope in patients2-6. However, the main drawback of this procedure is its inability to invoke presyncope in all individuals undergoing the test, and corresponding low sensitivity8,9. Thus, different methods were explored to increase the orthostatic stress and improve sensitivity.

Pharmacological provocation has been used to increase the orthostatic challenge, for example using isoprenaline4,7,10,11 or sublingual nitrate12,13. However, the main drawback of these approaches are increases in sensitivity at the cost of unacceptable decreases in specificity10,14, with a high positive response rate immediately after administration15. Furthermore, invasive procedures associated with some pharmacological provocations greatly increase the false positive rate1.

Another approach is to combine passive tilt testing with LBNP, providing a stronger orthostatic stress without invasive procedures or drug side-effects, using the technique pioneered by Professor Roger Hainsworth in the 1990s16-18. This approach provokes presyncope in almost all subjects (allowing for symptom recognition in patients with syncope), while discriminating between patients with syncope and healthy controls, with a specificity of 92%, sensitivity of 85%, and repeatability of 1.1±0.6 min16,17. This allows not only diagnosis and pathophysiological assessment19-22, but also the evaluation of treatments for orthostatic intolerance due to its high repeatability23-30. For these reasons, we argue this should be the “gold standard” for orthostatic stress testing, and accordingly this will be the method described in this paper.

Protocol

في جميع أنحاء، واختبار ضغط ضربات إلى فوز الدم المستمر والكهربائي (ECG) الرصد هو الهدف الأسمى. وهذا يضمن سلامة الموضوع، وإنهاء الفوري للاختبار مع بداية presyncope. فوز إلى فوز ويمكن الحصول على التسجيلات ضغط الدم من خلال قسطرة الشرايين، أو إصبع تخطيط التحجم 31-33. ويستخدم …

Representative Results

باستخدام هذا البروتوكول، جميع المواضيع presyncope الخبرة، وتعريف الاستجابات طبيعية أو غير طبيعية يتم يستند إلى حد كبير على الوقت الذي يستغرقه للحث على رد الفعل هذا. كما يتم تعريف OT الوقت لpresyncope في دقائق من بداية إمالة في وضع مستقيم. ويمكن رؤية القيم النموذجية لOT على متطوع…

Discussion

هذا الأسلوب هو استنساخه للغاية، لديه القدرة على التمييز الردود العادية وغير العادية مع حساسية عالية وخصوصية، ويمكن أن تثير presyncope في جميع المواد، مما يسمح للاعتراف أعراض في المرضى الذين يعانون من إغماء متكررة. في عملية إعداد سريرية، يمكن التمييز بين أنواع مختلفة من ?…

Disclosures

The authors have nothing to disclose.

Acknowledgements

نود أن نعترف البروفيسور روجر Hainsworth، الذي طور هذه التقنية. ونحن ممتنون لتعليق السيد تشاو الملك والسيد وانغ وو، جو لمساعدتهم مع التصوير الفوتوغرافي.

ويدعم هذا العمل من قبل جامعة سايمون فريزر ومؤسسة القلب والسكتة الدماغية من كندا.

Materials

Equipment Manufacturer Location
Tilt Table Custom-build Leeds, United Kingdom
Finometer Finapres Medical Systems Amsterdam, The Netherlands
Doppler Box Compumedics Singen, Germany
Doppler software The DWL Doppler Company Singen, Germany
Aquasonic Ultrasound gel Parker Laboratories, Inc. Fairfield, USA
Headbands Lululemon Burnaby, Canada
Headset Canadian Tire Burnaby, Canada
ECG Finapres ECG Module, Finapres Medical Systems Amsterdam, The Netherlands
Electrodes Red Dot Ontario, Canada
Antiseptic Isopropyl Alcohol Pads Lernapharm Quebec, Canada
O2Cap-Oxygen Analyser Oxigraph Inc. California, USA
Airlife Nasal Oxygen Cannula Cardinal Health Mountainview, USA
Powerlab 16/30 AD Instruments Colorado Springs, USA
DOWNLOAD MATERIALS LIST

References

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Tags

Tilt TestingCombined Lower Body Negative PressureOrthostatic ToleranceCardiovascular StabilitySyncopePresyncopal EventGravitational StressOrthostatic IntoleranceReproducibilityTherapeutic InterventionsInvasive ProceduresHead-upright Tilt TestingSyncope DiagnosisPostural Cardiovascular ReflexesTilting ProtocolsPharmacological ProvocationLBNP
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Protheroe, C. L., Ravensbergen, H. (. J., Inskip, J. A., Claydon, V. E. Tilt Testing with Combined Lower Body Negative Pressure: a “Gold Standard” for Measuring Orthostatic Tolerance. J. Vis. Exp. (73), e4315, doi:10.3791/4315 (2013).
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