Clinical phenotype of postural orthostatic tachycardia associated with anti-adrenergic receptor antibodies

  1. Fernández-Valle, Tamara 1
  2. Maria Ángeles Acera Gil 2
  3. Tijero, Beatriz 2
  4. Pérez-Concha, Tomás 3
  5. Del Pino, Rocío 4
  6. Murueta-Goyena, Ane 4
  7. Vicente-Lafuente, José 5
  8. Boyero, Sabas 6
  9. Ruiz-López, Marta 3
  10. Martínez-Alday, Jesús-Daniel 7
  11. Ugarte, Amaia 8
  12. Ruiz-Irastorza, Guillermo 8
  13. Ribacoba, Laureano 8
  14. López-de-Munain, Adolfo 9
  15. Gabilondo, Iñigo 10
  16. Gómez-Esteban, Juan-Carlos 1
  1. 1 (a) Basque Health Service-Osakidetza. Ezkerraldea-Enkarterri-Cruces Integrated Health Organization. Cruces University Hospital. Biocruces Bizkaia Health Research Institute. Neurodegenerative Diseases Group. Barakaldo, Spain. (b) Basque Health Service-Osakidetza. Ezkerraldea-Enkarterri-Cruces Integrated Health Organization. Cruces University Hospital. Neurology Department, Barakaldo, Spain. (c) University of the Basque Country (UPV/EHU). Department of Neuroscience. Leioa, Spain.
  2. 2 (d) San Juan de Dios Hospital. Autonomic Center (NeuroTek). Santurtzi, Spain.
  3. 3 (a) Basque Health Service-Osakidetza. Ezkerraldea-Enkarterri-Cruces Integrated Health Organization. Cruces University Hospital. Biocruces Bizkaia Health Research Institute. Neurodegenerative Diseases Group. Barakaldo, Spain. (b) Basque Health Service-Osakidetza. Ezkerraldea-Enkarterri-Cruces Integrated Health Organization. Cruces University Hospital. Neurology Department, Barakaldo, Spain.
  4. 4 (a) Basque Health Service-Osakidetza. Ezkerraldea-Enkarterri-Cruces Integrated Health Organization. Cruces University Hospital. Biocruces Bizkaia Health Research Institute. Neurodegenerative Diseases Group. Barakaldo, Spain.
  5. 5 (c) University of the Basque Country (UPV/EHU). Department of Neuroscience. Leioa, Spain.
  6. 6 (b) Basque Health Service-Osakidetza. Ezkerraldea-Enkarterri-Cruces Integrated Health Organization. Cruces University Hospital. Neurology Department, Barakaldo, Spain.
  7. 7 (f) Basque Health Service-Osakidetza. Bilbao-Basurto Integrated Health Organization. Cardiology Service. Arrhythmia Unit. Bilbao, Spain.
  8. 8 (g) Basque Health Service-Osakidetza. Ezkerraldea-Enkarterri-Cruces Integrated Health Organization. Cruces University Hospital. Biocruces Bizkaia Health Research Institute. Internal Medicine Department. Autoimmune Diseases Research Unit. Barakaldo, Spain.
  9. 9 (h) Basque Health Service-Osakidetza. Donostialdea Integrated Health Organization. Donostia University Hospital. Biodonostia Health Research Institute. Neurosciences Area. San Sebastian, Spain. (i) Department of Neurology. University Donostia Hospital, San Sebastian, Spain.
  10. 10 (e) Ikerbasque: The Basque Foundation for Science. Bilbao, Spain.
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Journal:
Gaceta médica de Bilbao: Revista oficial de la Academia de Ciencias Médicas de Bilbao. Información para profesionales sanitarios

ISSN: 0304-4858,  2173-2302

Year of publication: 2023

Volume: 120

Issue: 2

Pages: 66-73

Type: Article

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More publications in: Gaceta médica de Bilbao: Revista oficial de la Academia de Ciencias Médicas de Bilbao. Información para profesionales sanitarios

Abstract

Purpose: Our aim is to describe the clinical and hemodynamic characteristics of autoimmune postural orthostatic tachycardia syndrome (POTS), an entity whose frequency and clinical characteristics are not sufficiently defined yet.Methods: We retrospectively analyzed clinical, hemodynamic and serum autoimmunity biomarkers in 105 POTS patients and 79 age-sex-matched controls. We recorded clinical manifestations and relevant comorbidities. Participants underwent non-invasive quantitative cardiovascular autonomic testing by measuring changes in heart rate (HR) and blood pressure (BP), baroreflex sensitivity (BRS), total periph-eral resistance (TPR), stroke volume (SV) and cardiac index in response to deep breathing, valsalva maneuver, 60º head-up tilt, and quantitative evaluation of electrochemical skin conductance. In 61 POTS patients and 15 controls we quan-tified autoantibodies against adrenergic receptors (AR) alpha1 (anti-a1AR), beta1 (anti-b1AR), and beta2 (anti-b2AR) and antinuclear antibodies.Results: Joint hypermobility and chronic fatigue syndrome-fibromyalgia was significantly higher in POTS. We observed significant differences in cardiovascular autonomic tests with higher HR increase, lower TPR at 3 min in the tilt test, and higher BRS. AR antibodies were significantly higher in POTS (62%) than in controls (17%), with anti-a1AR in all antibody-positive POTS, 21.1% POTS had a combination of anti-a1AR with other AR antibodies. The presence of palpitations and orthostatic intolerance was significantly higher in anti-AR positive.Conclusion: Our results suggest that the prevalence of anti-AR antibodies is significantly higher in POTS, with the levels of such antibodies being correlated with the presence of symptoms associated with POTS.

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