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Advances in Postural Orthostatic Tachycardia Syndrome (POTS)
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Advances in Postural Orthostatic Tachycardia Syndrome (POTS)

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (30 September 2024) | Viewed by 20237

Special Issue Editors

Dr. Fabrizio Ricci

E-Mail Website
Guest Editor
Department of Neuroscience, Imaging and Clinical Sciences, “G.d’Annunzio” University of Chieti-Pescara, Chieti, Italy
Interests: cardiovascular magnetic resonance; multi-modality cardiac imaging; heart valve disease; coronary artery disease; sudden cardiac death; mitral valve prolapse; hypertrophic cardiomyopathy; dilated cardiomyopathy; cardiac amyloidosis; arrhythmogenic cardiomyopathy; sports cardiology; heart failure; cardiovascular autonomic dysfunction; COVID-19
Special Issues, Collections and Topics in MDPI journals
Dr. Madeleine Johansson

E-Mail Website
Guest Editor
1. Department of Clinical Sciences, Lund University, Malmö, Sweden
2. Department of Cardiology, Skåne University Hospital, Malmö, Sweden
Interests: cardiovascular disease; orthostatic hypotension; syncope; POTS; vascular ageing; aortic stiffness; cardiovascular autonomic dysfunction; COVID-19

Special Issue Information

Dear Colleagues,

We are pleased to introduce a Special Issue in the Journal of Clinical Medicine, titled "Advances in Postural Orthostatic Tachycardia Syndrome (POTS)".

POTS is a common and therapeutically challenging condition affecting numerous people worldwide. POTS is a chronic multi-system disorder involving the autonomic nervous system that is characterized by an excessive increase in heart rate upon standing, accompanied by persistent orthostatic intolerance symptoms. POTS predominantly affects young women, and it has a considerable impact on patients’ health-related quality of life.

Pathophysiology is incompletely understood, which is likely responsible for the limited data on effective treatments. Despite ongoing research efforts, substantial knowledge gaps remain, and a scarcity of validated interventions hinders healthcare professionals from providing optimal care to POTS patients. Focused research studies on the pathophysiology and treatment of POTS have the potential to significantly improve the lives of patients with POTS.

In this Special Issue, we welcome the submission of your original research and review articles focusing on the latest advances and developments in POTS. Particularly, we encourage submissions on the following POTS-related topics:

  • Biomarkers;
  • Pathophysiology;
  • Genetics;
  • Symptoms and quality of life;
  • Antibodies and immunology;
  • Pharmacological interventions;
  • Non-pharmacologic management.

We eagerly await your valuable contributions.

Sincerely,
Dr. Fabrizio Ricci
Dr. Madeleine Johansson
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • postural orthostatic tachycardia syndrome
  • biomarkers
  • pathophysiology
  • treatment
  • autoimmunity
  • autonomic dysfunction
  • symptoms
  • long-COVID-19

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (4 papers)

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Research

19 pages, 980 KiB  
Article
Two Different Hemodynamic Responses in ME/CFS Patients with Postural Orthostatic Tachycardia Syndrome During Head-Up Tilt Testing
by C. (Linda) M. C. van Campen, Peter C. Rowe and Frans C. Visser
J. Clin. Med. 2024, 13(24), 7726; https://doi.org/10.3390/jcm13247726 - 18 Dec 2024
Viewed by 2313
Abstract
Introduction: While the diagnosis of postural orthostatic tachycardia syndrome (POTS) is based on heart rate (HR) and blood pressure (BP) criteria, the pathophysiology of POTS is not fully understood as multiple pathophysiological mechanisms have been recognized. Also, cardiac function, being dependent on [...] Read more.
Introduction: While the diagnosis of postural orthostatic tachycardia syndrome (POTS) is based on heart rate (HR) and blood pressure (BP) criteria, the pathophysiology of POTS is not fully understood as multiple pathophysiological mechanisms have been recognized. Also, cardiac function, being dependent on preload, afterload, contractility, and HR, has not been properly studied. Preload and contractility changes can be inferred from stroke volume index (SVI) changes during a tilt test. Afterload plays a minor role in POTS as a normal BP response is a prerequisite for POTS. Therefore, we analyzed the HR-SVI relation during a tilt test in myalgic encephalomyelitis (ME/CFS) patients with POTS and compared the data with ME/CFS patients with a normal HR-BP response and with that of healthy controls (HC). Material and Methods: In ME/CFS patients with either POTS (n = 233) or a normal HR-BP response (n = 507) and healthy controls (n = 48), we measured SVI (by suprasternal echo), HR, and BP during the tilt. Results: In all ME/CFS patients, the decrease in SVI was larger compared to HC. In patients with a normal HR-BP response and in POTS patients with a HR increase between 30–39 bpm, there was an inverse relationship between the HR increase and SVI decrease during the tilt, compatible with increased venous pooling. In POTS patients with a HR increase ≥40 bpm, this inverse relation was lost, and SVI changes were significantly less compared to POTS patients with a HR increase between 30–39 bpm, suggestive of a hyperadrenergic response. Conclusions: In ME/CFS patients with POTS, two different hemodynamic profiles can be observed: in patients with a limited HR increase, mainly increased venous pooling is observed, while in patients with a large (≥ 40 bpm) HR increase the data are suggestive of a hyperadrenergic response. These two different profiles may have different therapeutic implications. Full article
(This article belongs to the Special Issue Advances in Postural Orthostatic Tachycardia Syndrome (POTS))
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12 pages, 1333 KiB  
Article
Current Landscape of Compression Products for Treatment of Postural Orthostatic Tachycardia Syndrome and Neurogenic Orthostatic Hypotension
by Kishen Mitra, Sameer Kunte, Sara Taube, William Tian, Eric Richardson, Camille Frazier-Mills and Marat Fudim
J. Clin. Med. 2024, 13(23), 7304; https://doi.org/10.3390/jcm13237304 - 1 Dec 2024
Viewed by 1430
Abstract
Background/Objectives: Patients with postural orthostatic tachycardia syndrome (POTS) or neurogenic orthostatic hypotension (nOH) experience vertigo, confusion, and syncope. Compression garments help reduce venous pooling in these patients, thereby increasing cardiac output. We aimed to determine end-user opinions of compression products intended to [...] Read more.
Background/Objectives: Patients with postural orthostatic tachycardia syndrome (POTS) or neurogenic orthostatic hypotension (nOH) experience vertigo, confusion, and syncope. Compression garments help reduce venous pooling in these patients, thereby increasing cardiac output. We aimed to determine end-user opinions of compression products intended to alleviate symptoms for POTS and nOH. Methods: This was a survey study sampling participants diagnosed with POTS or nOH. The data collected included demographics, medical history, and compression garments previously used. The participants rated their most frequently used garment across comfort, aesthetic appeal, ease of use, durability, cost-effectiveness, efficacy, and consistency on the Likert scale (1–5). One-way ANOVA was used to compare the design criteria ratings across garments. For all tests α = 0.05. Results: Of the 330 POTS and 28 nOH participants surveyed (mean age 37.9, mean BMI 27.5, 95.0% women, 90.5% White), 354 (98.9%) reported trying at least one compression garment since their diagnosis. The majority of participants reported using leg compression most frequently rather than shapewear or abdominal compression (65.4% vs. 20.1% vs. 13.4%, respectively). Approximately 67.0% of participants tried multiple product types. Shapewear was reported to have greater concealability compared to abdominal or leg compression garments (mean 3.43 vs. 2.90 vs. 2.91, respectively; p < 0.01). Shapewear and abdominal compression were rated to be less comfortable compared to leg compression (2.67 vs. 2.94 vs. 3.05, respectively; p = 0.03). Conclusions: The existing compression products do not fully meet needs of individuals with POTS or nOH, as evidenced by participant ratings on multiple domains. There is potential consumer demand for novel adjustable abdominal compression garments that are low-profile and comfortable when disengaged. Full article
(This article belongs to the Special Issue Advances in Postural Orthostatic Tachycardia Syndrome (POTS))
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13 pages, 886 KiB  
Article
Sexual Dysfunction in Postural Orthostatic Tachycardia Syndrome (POTS): A Cross-Sectional, Case-Control Study
by Svetlana Blitshteyn, Anna Lange, Chelsea Corinaldi, Paige Guy and Jill Brook
J. Clin. Med. 2024, 13(8), 2274; https://doi.org/10.3390/jcm13082274 - 14 Apr 2024
Cited by 1 | Viewed by 11388
Abstract
Background: We aimed to determine whether patients with postural orthostatic tachycardia syndrome (POTS) have sexual dysfunction compared to age-matched healthy controls. Methods: Utilizing online COMPASS-31 to evaluate dysautonomia symptom severity, Beck’s Depression Inventory Second Edition (BDII), Female Sexual Function (FSF), and International Index [...] Read more.
Background: We aimed to determine whether patients with postural orthostatic tachycardia syndrome (POTS) have sexual dysfunction compared to age-matched healthy controls. Methods: Utilizing online COMPASS-31 to evaluate dysautonomia symptom severity, Beck’s Depression Inventory Second Edition (BDII), Female Sexual Function (FSF), and International Index of Erection Function (IIEF) questionnaires, we compared sexual function scores in patients with POTS to scores obtained from sex- and age-matched healthy controls via a cross-sectional case–control study. Results: A total of 160 women with POTS, mean age 30.2 ± 7.9 (range 21–50 years), had lower FSF scores than 62 healthy age-matched female controls. IIEF scores in 29 male patients with POTS with a mean age of 30.1 ± 6.0 (range 21–47) were significantly lower than in 27 healthy age-matched male controls. Female POTS patients had significantly lower scores in the sub-domains of desire, arousal, and satisfaction, while male POTS patients had significantly lower scores in erectile and orgasmic function, desire, and satisfaction than healthy controls. Predictive factors of sexual dysfunction were depression in women and age in men. The severity of autonomic symptoms correlated with sexual dysfunction in women, but this effect disappeared after controlling for depression. Conclusions: Compared to healthy controls, women and men with POTS have significant sexual dysfunction, which needs to be considered in the diagnostic and therapeutic approaches as part of comprehensive patient care. Full article
(This article belongs to the Special Issue Advances in Postural Orthostatic Tachycardia Syndrome (POTS))
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11 pages, 2850 KiB  
Article
Evidence for Impaired Renin Activity in Postural Orthostatic Tachycardia Syndrome
by Jasmina Medic Spahic, Ingrid Yao Mattisson, Viktor Hamrefors, Madeleine Johansson, Fabrizio Ricci, Jan Nilsson, Olle Melander, Richard Sutton and Artur Fedorowski
J. Clin. Med. 2023, 12(14), 4660; https://doi.org/10.3390/jcm12144660 - 13 Jul 2023
Cited by 4 | Viewed by 3674
Abstract
Background: Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous condition predominantly affecting autonomic control of the cardiovascular system. Its extensive symptom diversity implies multi-organ involvement that interacts in ways still requiring full exploration. Current understanding of POTS pathophysiology suggests alterations in the renin–angiotensin–aldosterone [...] Read more.
Background: Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous condition predominantly affecting autonomic control of the cardiovascular system. Its extensive symptom diversity implies multi-organ involvement that interacts in ways still requiring full exploration. Current understanding of POTS pathophysiology suggests alterations in the renin–angiotensin–aldosterone system as a possible contributing factor. Therefore, we investigated the relationship between the activity of the renin–angiotensin–aldosterone system and hemodynamic parameters in a cohort of POTS patients and controls recruited at a tertiary referral center. Methods: The case-control study included 46 patients with POTS (27 ± 9 years), and 48 healthy controls (30 ± 9 years) without orthostatic intolerance. Plasma renin activity, expressed as angiotensin I generation, and plasma aldosterone were measured by enzyme-linked immunosorbent assay and were correlated with hemodynamic parameters obtained during active standing tests. Results: Renin activity was significantly downregulated in POTS patients compared to healthy individuals (median, 3406 ng/mL vs. 9949 ng/mL, p < 0.001), whereas aldosterone concentration did not differ between POTS and healthy controls (median, 218 pmol/L vs. 218 pmol/L, p = 0.26). A significant inverse correlation between renin activity and supine and orthostatic blood pressure levels was observed in healthy individuals (p < 0.05 for all), but not in POTS patients. Conclusions: Renin activity, but not aldosterone concentration, is downregulated in patients with POTS. Moreover, renin activity in POTS is dissociated from supine and standing blood pressure levels in contrast to healthy individuals. These findings suggest impaired renin function in POTS, which may direct future therapeutic approaches. Full article
(This article belongs to the Special Issue Advances in Postural Orthostatic Tachycardia Syndrome (POTS))
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