Reduced stroke volume during exercise in postural tachycardia syndrome

Departments of 1 Anesthesiology and 2 Neurology, Mayo Clinic and Foundation, Rochester, Minnesota; and 3 Department of Sports Medical Sciences, Shinshu University Graduate School of Medicine, Matsumoto, Japan Submitted 11 February 2007 ; accepted in final form 5 July 2007 Postural tachycardia syndrome (POTS) is characterized by excessive tachycardia without hypotension during orthostasis. Most POTS patients also report exercise intolerance. To assess cardiovascular regulation during exercise in POTS, patients ( n = 13) and healthy controls ( n = 10) performed graded cycle exercise at 25, 50, and 75 W in both supine and upright positions while arterial pressure (arterial catheter), heart rate (HR; measured by ECG), and cardiac output (open-circuit acetylene breathing) were measured. In both positions, mean arterial pressure, cardiac output, and total peripheral resistance at rest and during exercise were similar in patients and controls ( P > 0.05). However, supine stroke volume (SV) tended to be lower in the patients than controls at rest (99 ± 5 vs. 110 ± 9 ml) and during 75-W exercise (97 ± 5 vs. 111 ± 7 ml) ( P = 0.07), and HR was higher in the patients than controls at rest (76 ± 3 vs. 62 ± 4 beats/min) and during 75-W exercise (127 ± 3 vs. 114 ± 5 beats/min) (both P < 0.01). Upright SV was significantly lower in the patients than controls at rest (57 ± 3 vs. 81 ± 6 ml) and during 75-W exercise (70 ± 4 vs. 94 ± 6 ml) (both P < 0.01), and HR was much higher in the patients than controls at rest (103 ± 3 vs. 81 ± 4 beats/min) and during 75-W exercise (164 ± 3 vs. 131 ± 7 beats/min) (both P < 0.001). The change (upright – supine) in SV was inversely correlated with the change in HR for all participants at rest ( R 2 = 0.32), at 25 W ( R 2 = 0.49), 50 W ( R 2 = 0.60), and 75 W ( R 2 = 0.32) ( P < 0.01). These results suggest that greater elevation in HR in POTS patients during exercise, especially while upright, was secondary to reduced SV and associated with exercise intolerance. cardiac output; blood pressure; deconditioning; orthostatic intolerance Address for reprint requests and other correspondence: M. J. Joyner, Dept. of Anesthesiology, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN 55905 (e-mail: joyner.michael{at}mayo.edu )