Assessment of Antibodies and Inflammatory Markers in Postural Tachycardia Syndrome

Study Overview
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Brief Summary
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In this pilot study, the investigators will test the hypothesis that patients with postural tachycardia syndrome will have an elevated percentage of functional antibodies to adrenergic receptors compared with control subjects without POTS. The investigators further hypothesize that the percentage of POTS patients with antibodies will be higher in those patients with a viral infection at the onset of their illness than in those patients with other or undefined illness onsets.

Detailed Description
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Postural orthostatic tachycardia syndrome is poorly understood. Many of these patients have elevated levels of plasma norepinephrine, particularly when upright One subgroup of patients has a primary hyperadrenergic state. The majority of patients have a marked deficit in plasma blood volume compared to healthy control subjects. The investigators have previously reported that some patients suffer paradoxically from a partial dysautonomia affecting the lower limbs. Most patients seem to suffer from either a primary or secondary increase in central sympathetic nervous system drive. Recent data have shown that patients with postural orthostatic tachycardia syndrome have a lower cardiac stroke volume than their healthy counterparts and this low stroke volume may drive their orthostatic tachycardia. The investigators plan to do the following: The physical examination will include (at minimum): Height Weight Orthostatic vital signs (heart rate and blood pressure) Supine and Standing for up to 10 minutes Beighton Criteria for Joint Hypermobility Syndrome (Ehlers-Danlos III) Dependent acrocyanosis (during stand test) Continuous Heart Rate and Blood Pressure Recording A subset of subjects will be given the opportunity to also have continuous recordings of heart rate and blood pressure for 5-10 minutes while lying down quietly. They will be instrumented with EKG patches on their body and a finger blood pressure cuff, and these data will be digitally sampled and acquired on a dedicated laptop computer for later offline analysis. There will be an optional rider on the consent form to allow the patient to consent to this portion of the study. Blood work Blood will be drawn for future assay and analysis of the following tests: Antibodies regulating cardiovascular function o The clinical significance of these antibodies is unknown. The investigators will share the results of the antibody panel with the subject, but with the caveat that no clinical interpretation or comment on significance can be made. Inflammatory markers The total amount of blood drawn for this project will be less than 15 ml. Questionnaires RAND-36 Health Thermometer Chandler Fatigue Scale Daily diary of Fatigue Symptoms - Fibromyalgia Pain Detect Questionnaire Orthostatic Grading Scale COMPASS-31 Structured History (including some of the elements from section 6.1) These questionnaires will be completed directly online (web-based interface) using a personalized link that will be provided to the subjects after they give their informed consent. These will be created in a REDCap-Survey environment, with the data collected and stored on a password-protected, HIPAA-compliant, secure computer server.

Official Title
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Assessment of Antibodies and Inflammatory Markers in Postural Tachycardia Syndrome

Conditions
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Postural Orthostatic Tachycardia Syndrome

Intervention / Treatment
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* Other: History
* Other: Physical
* Other: blood draw
* Behavioral: Questionnaires


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Postural Tachycardia Syndrome Previously diagnosed with POTS Control Subjects Not diagnosed with POTS Age between 13-80 years Male and female subjects are eligible. Able and willing to provide informed consent Exclusion Criteria: Inability to give, or withdrawal of, informed consent Other factors which in the investigator's opinion would prevent the subject from completing the protocol.

Ages Eligible for Study
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Minimum Age: 13 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| orthostatic tachycardia syndrome<br>participants with postural orthostatic tachycardia syndrome | Other: History<br>* the physician / PI will conduct a history that may include: demographics Framingham risk factors metabolic diseases inflammatory diseases autoimmune disorders review of medications date of last menstrual period (females) family history of autonomic disorders Onset of postural orthostatic tachycardia syndrome<br>Other: Physical<br>* the physical exam will include: height weight orthostatic vitals (heart rate and blood pressure), supine and standing for up to 10 minutes. Beighton Criteria for Join Hypermobility Syndrome Dependent acrocyanosis<br>Other: blood draw<br>* blood will be drawn for: antibodies regulating cardiovascular function inflammatory markers no more than 15 ml (1 TBSP) will be drawn.<br>Behavioral: Questionnaires<br>* The questionnaires will be completed directly online (web-based interface) using a personalized link that will be provided to the subjects after they give their informed consent. These will be created in a REDCap-Survey environment, with the data collected and stored on a password-protected, HIPAA-compliant, secure computer server. The following questionnaires will be conducted: RAND-36 Health Thermometer Chalder Fatigue Scale Daily diary of Fatigue Symptoms - Fibromyalgia Pain Detect Questionnaire Orthostatic Grading Scale COMPASS-31<br>|
| control subjects<br>participants not diagnosed with postural orthostatic tachycardia syndrome | Other: History<br>* the physician / PI will conduct a history that may include: demographics Framingham risk factors metabolic diseases inflammatory diseases autoimmune disorders review of medications date of last menstrual period (females) family history of autonomic disorders Onset of postural orthostatic tachycardia syndrome<br>Other: Physical<br>* the physical exam will include: height weight orthostatic vitals (heart rate and blood pressure), supine and standing for up to 10 minutes. Beighton Criteria for Join Hypermobility Syndrome Dependent acrocyanosis<br>Other: blood draw<br>* blood will be drawn for: antibodies regulating cardiovascular function inflammatory markers no more than 15 ml (1 TBSP) will be drawn.<br>Behavioral: Questionnaires<br>* The questionnaires will be completed directly online (web-based interface) using a personalized link that will be provided to the subjects after they give their informed consent. These will be created in a REDCap-Survey environment, with the data collected and stored on a password-protected, HIPAA-compliant, secure computer server. The following questionnaires will be conducted: RAND-36 Health Thermometer Chalder Fatigue Scale Daily diary of Fatigue Symptoms - Fibromyalgia Pain Detect Questionnaire Orthostatic Grading Scale COMPASS-31<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ab titer in POTS patients compared to control subjects | The primary outcome measure will be the proportion of subjects with alpha-1 Ab titer. The primary comparison will be the proportion of Ab titers between POTS patients compared to control subjects. | One time only, at first visit | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| comparison of the number of POTS patients with viral based Ab versus non-viral based Ab | Blood samples will be collected at study visit. | One time only - at first study visit | 
| comparison of the number of POTS patients with and without Ehlers Danlos syndrome III | Ehlers Danlos Syndrome will be assessed during the physical exam. The hypermobility assessment (Beighton Score) will be used. | One time only - at first study visit | 
| comparison of the number of POTS patients with a history of autoimmune disorders versus no history of auto-immune disorders | History of auto-immune disorders will be collected during the history and physical performed by the physician. | One time only - at first study visit | 
| comparison of the number of POTS patients with fatigue versus no history of fatigue based on severity of impact on normal daily activities. | Fatigue will be assessed using the RAND-36 Health Thermometer Chalder Scale of Fatigue, and Daily Diary of Fatigue. | One time only - at first study visit | 
| comparison of pain in POTS patients versus non-POTS patients | Pain will be assessed using Fibromyalgia Pain Detect Questionnaire, Orthostatic Grading Scale and COMPASS-31. | One time only - at first study visit | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Postural orthostatic syndrome, orthostatic intolerance, autonomic dysfunction