Abstract Details

Title Beyond Postural Tachycardia: Comparison of Autonomic Symptom Severity and Testing Between Postural Tachycardia Syndrome and Orthostatic Intolerance without Tachycardia

Topic Autonomic Disorders

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 7-008

Objective To explore the clinical phenotypes and autonomic testing results of individuals with postural tachycardia syndrome (POTS) and orthostatic intolerance without tachycardia (OIwoT).

Background POTS is a debilitating form of dysautonomia associated with multisystem symptoms, including lightheadedness, tachycardia, nausea, constipation or diarrhea, difficulty concentrating, activity intolerance, and abnormal sweating, among others. Individuals with OIwoT also report similar autonomic complaints. There is limited data exploring how clinical phenotypes and objective testing differ between individuals with POTS and OIwoT.

Design/Methods This is a single-site, observational cohort study of adults who presented to an academic autonomic laboratory and met laboratory diagnostic criteria for POTS or had OIwoT. Exclusion criteria included: age <19 or >65, meeting laboratory criteria for orthostatic hypotension and medications that could affect testing. The Composite Autonomic Symptom Score-31 (COMPASS-31) total score and subscores were used to evaluate patient-reported autonomic symptoms. Participants were classified into two phenotypes based on laboratory testing: 1) hyperadrenergic phenotype if standing norepinephrine was >600 pg/mL and/or >3 times the supine norepinephrine level, and 2) neuropathic phenotype with Composite Autonomic Scoring Scale (CASS) score ≥2.

Results This analysis included 389 individuals with POTS (mean age 32 years, 91% female) and 287 with OIwoT (mean age 36 years, 88% female). Median COMPASS-31 total score and domain subscores did not differ between POTS and OIwoT. The hyperadrenergic phenotype was more frequent in individuals with POTS (N=162 (74%) vs. N=114 (64%), p=0.02), whereas the frequency of the neuropathic phenotype did not differ between POTS and OIwoT.

Conclusions People with POTS and OIwoT have similar autonomic symptom severity and findings on the autonomic reflex screen, while high central sympathetic drive and/or an excessive sympathetic response to standing are more common in POTS compared to OIwoT. Further studies are needed to confirm these findings and their impact on diagnosis and management.

Authors/Disclosures
Jonathan Trout, MD PRESENTER	Dr. Trout has nothing to disclose.
Jordan Langford, MD	Jordan Langford, MD has nothing to disclose.
Luke Heyliger, MD (University of Utah)	Dr. Heyliger has nothing to disclose.
Guillaume Lamotte, MD	Dr. Lamotte has nothing to disclose.
Melissa M. Cortez, DO (University of Utah Neurology)	The institution of Dr. Cortez has received research support from NIH NINDS. The institution of Dr. Cortez has received research support from Dysautonomia International. Dr. Cortez has received personal compensation in the range of $500-$4,999 for serving as a Content Expert, Reviewer, DSMB with NIH RECOVER project.

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