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Diagnosing postural tachycardia syndrome: comparison of tilt testing compared with standing haemodynamics Plash WB; Diedrich A; Biaggioni I; Garland EM; Paranjape SY; Black BK; Dupont WD; Raj SRClin Sci (Lond) 2013[Jan]; 124 (2): 109-14POTS (postural tachycardia syndrome) is characterized by an increased heart rate (DeltaHR) of >/=30 bpm (beats/min) with symptoms related to upright posture. Active stand (STAND) and passive head-up tilt (TILT) produce different physiological responses. We hypothesized these different responses would affect the ability of individuals to achieve the POTS HR increase criterion. Patients with POTS (n=15) and healthy controls (n=15) underwent 30 min of tilt and stand testing. DeltaHR values were analysed at 5 min intervals. ROC (receiver operating characteristic) analysis was performed to determine optimal cut point values of DeltaHR for both tilt and stand. Tilt produced larger DeltaHR than stand for all 5 min intervals from 5 min (38+/-3 bpm compared with 33+/-3 bpm; P=0.03) to 30 min (51+/-3 bpm compared with 38+/-3 bpm; P<0.001). Sn (sensitivity) of the 30 bpm criterion was similar for all tests (TILT10=93%, STAND10=87%, TILT30=100%, and STAND30=93%). Sp (specificity) of the 30 bpm criterion was less at both 10 and 30 min for tilt (TILT10=40%, TILT30=20%) than stand (STAND10=67%, STAND30=53%). The optimal DeltaHR to discriminate POTS at 10 min were 38 bpm (TILT) and 29 bpm (STAND), and at 30 min were 47 bpm (TILT) and 34 bpm (STAND). Orthostatic tachycardia was greater for tilt (with lower Sp for POTS diagnosis) than stand at 10 and 30 min. The 30 bpm DeltaHR criterion is not suitable for 30 min tilt. Diagnosis of POTS should consider orthostatic intolerance criteria and not be based solely on orthostatic tachycardia regardless of test used.|Adult[MESH]|Female[MESH]|Heart Rate/*physiology[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Postural Orthostatic Tachycardia Syndrome/*diagnosis[MESH]|Posture[MESH]|ROC Curve[MESH]|Retrospective Studies[MESH]|Sensitivity and Specificity[MESH]|Tennessee[MESH]|Tilt-Table Test/*methods[MESH]|Time Factors[MESH] |
