Work Ability Assessment and Its Relationship with Cardiovascular Autonomic Profile in Postural Orthostatic Tachycardia Syndrome.

Franca Barbic,Beatrice Cairo,Alberto Porta,Maura Minonzio,Silvia Cavalieri,Antonio Roberto Zamuner,Raffaello Furlan,Nicola Magnavita,Franca Dipaola,Dana Shiffer

doi:10.3390/ijerph17217836

Abstract

Postural orthostatic tachycardia syndrome (POTS) negatively impacts quality of life. The excessive increase in cardiac sympathetic modulation during standing, which characterizes POTS patients, leads to many symptoms and signs of orthostatic intolerance. Little is known about the consequences of the disease on work performance and its relationship with individual autonomic profiles. Twenty-two POTS patients regularly engaged in working activity (20 females, age 36 ± 12 years) and 18 gender- and age-matched controls underwent a clinical evaluation and filled out the Work Ability Index (WAI) questionnaire. POTS patients completed the Composite Autonomic Symptom Score (COMPASS31) questionnaire, underwent continuous electrocardiogram, blood pressure and respiratory activity recordings while supine and during a 75° head-up tilt (HUT). A power spectrum analysis provided the index of cardiac sympatho-vagal balance (LF/HF). WAI scores were significantly reduced in POTS patients (29.84 ± 1.40) compared to controls (45.63 ± 0.53, p < 0.01). A significant inverse correlation was found between individual WAI and COMPASS31 scores (r = −0.46; p = 0.03), HUT increase in heart rate (r = −0.57; p = 0.01) and LF/HF (r = −0.55; p = 0.01). In POTS patients, the WAI scores were inversely correlated to the intensity of autonomic symptoms and to the excessive cardiac sympathetic activation induced by the gravitational stimulus.

Highlights

Postural orthostatic tachycardia syndrome (POTS) is an autonomic disorder characterized by a marked increase in heart rate (>30 beats per minute) or tachycardia (>120 beats per minute) upon standing or when exposed to a passive gravitational stimulus without orthostatic hypotension
Mitral prolapse was reported by four POTS patients
The main results of the present study indicate that our POTS patients, regularly engaged in work activity, are characterized by a moderate-severe burden of autonomic symptom intensity, and by a concomitant reduced global work ability compared to healthy controls

Summary

Introduction

Postural orthostatic tachycardia syndrome (POTS) is an autonomic disorder characterized by a marked increase in heart rate (>30 beats per minute) or tachycardia (>120 beats per minute) upon standing or when exposed to a passive gravitational stimulus (i.e., head-up tilt) without orthostatic hypotension. The disorder usually fasts for more than 6 months. Excessive orthostatic tachycardia can be considered a final common pathway that is responsible for most of the orthostatic intolerance symptoms reported by patients [1,2,3,4]. These are related either to cerebral hypoperfusion (lightheadedness, weakness, blurred vision, pre-syncope and, rarely, syncope) [1,4,5] or to excessive sympathetic activation (intolerable palpitations, nausea, tremulousness, and anxiety) [1,2]. The pathophysiological mechanisms of POTS remain poorly understood and three different phenotypes are described: the “hyper-adrenergic” [3], the “neuropathic” [6,7,8]

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