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(Stroke. 2000;31:1608.)
© 2000 American Heart Association, Inc.

Original Contributions

Orthostatic Tolerance, Cerebral Oxygenation, and Blood Velocity in Humans With Sympathetic Failure

M.P.M. Harms, MD; W.N.J.M. Colier, PhD; W. Wieling, MD, PhD; J.W.M. Lenders, MD, PhD; N.H. Secher, MD, PhD J.J. van Lieshout, MD, PhD¹

From the Department of Internal Medicine, Academic Medical Center Amsterdam (M.P.M.H., W.W., J.J. van L.); Cardiovascular Research Institute, Amsterdam (M.P.M.H., W.W., J.J. van L.); Departments of Physiology (W.N.J.M.C.) and Internal Medicine (J.W.M.L.), University Hospital Nijmegen; and Department of Anesthesia, Copenhagen Muscle Research Center, Rigshospitalet, Copenhagen (N.H.S.), Denmark.

Correspondence to J.J. van Lieshout, Department of Internal Medicine, Room F4-264, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands. E-mail j.j.vanlieshout{at}amc.uva.nl

Background and Purpose—Patients with orthostatic hypotension due to sympathetic failure become symptomatic when standing, although their capability to maintain cerebral blood flow is reported to be preserved. We tested the hypothesis that in patients with sympathetic failure, orthostatic symptoms reflect reduced cerebral perfusion with insufficient oxygen supply.

Methods—This study addressed the relationship between orthostatic tolerance, mean cerebral artery blood velocity (V_mean, determined by transcranial Doppler ultrasonography), oxygenation (oxyhemoglobin [O₂Hb], determined by near-infrared spectroscopy), and mean arterial pressure at brain level (MAP_MCA, determined by finger arterial pressure monitoring [Finapres]) in 9 patients (aged 37 to 70 years; 4 women) and their age- and sex-matched controls during 5 minutes of standing.

Results—Supine MAP_MCA (108±14 versus 86±14 mm Hg) and V_mean (84±21 versus 62±13 cm · s^-1) were higher in the patients. After 5 minutes of standing, MAP_MCA was lower in the patients (31±14 versus 72±14 mm Hg), as was V_mean (51±8 versus 59±9 cm · s^-1), with a larger reduction in O₂Hb (-11.6±4 versus -6.7±4.5 µmol · L^-1). Four patients terminated standing after 1 to 3.5 minutes. In these symptomatic patients, the orthostatic fall in V_mean was greater (45±6 versus 64±10 cm · s^-1), and the orthostatic decrease in O₂Hb (-12.0±3.3 versus -7.6±3.9 µmol · L^-1) tended to be larger. The reduction in MAP_MCA was larger after 10 seconds of standing, and MAP_MCA was lower after 1 minute (25±8 versus 40±6 mm Hg).

Conclusions—In patients with sympathetic failure, the orthostatic reduction in cerebral blood velocity and oxygenation is larger. Patients who become symptomatic within 5 minutes of standing are characterized by a pronounced orthostatic fall in blood pressure, cerebral blood velocity, and oxygenation manifest within the first 10 seconds of standing.

Key Words: cardiac output • hypotension, orthostatic • posture • ultrasonography, Doppler, transcranial

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