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Novel inflammatory biomarkers in postural orthostatic tachycardia syndrome

Nawaz, Sara ; Larsson, Anders ; Hamrefors, Viktor LU orcid ; Ruge, Toralph ; Sutton, Richard LU ; Olshansky, Brian ; Fedorowski, Artur LU orcid and Johansson, Madeleine LU orcid (2023) European Heart Rhythm Association (EHRA) Congress 2023 In Europace p.345-345
Abstract
Introduction
Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder characterized by excessive orthostatic tachycardia and orthostatic intolerance. While traditional inflammatory biomarkers tend to be normal, a subclinical inflammatory process may be present in POTS.

Purpose
We aimed to analyse novel inflammatory biomarkers in POTS patients: Growth Differentiation Factor 15 (GDF15), Neutrophil Gelatinase Associated Lipocalin (NGAL), Intercellular Adhesion Molecule 1 (ICAM-1), Tumour Necrosis Factor Receptor 1 (TNFR1) and Tumour Necrosis Factor Receptor 2 (TNFR2) and compared them to healthy controls. These inflammatory biomarkers have been shown to be independent predictors of major adverse cardiovascular events in... (More)
Introduction
Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder characterized by excessive orthostatic tachycardia and orthostatic intolerance. While traditional inflammatory biomarkers tend to be normal, a subclinical inflammatory process may be present in POTS.

Purpose
We aimed to analyse novel inflammatory biomarkers in POTS patients: Growth Differentiation Factor 15 (GDF15), Neutrophil Gelatinase Associated Lipocalin (NGAL), Intercellular Adhesion Molecule 1 (ICAM-1), Tumour Necrosis Factor Receptor 1 (TNFR1) and Tumour Necrosis Factor Receptor 2 (TNFR2) and compared them to healthy controls. These inflammatory biomarkers have been shown to be independent predictors of major adverse cardiovascular events in other populations.

Methods
An age- and sex-matched case-control study included 65 patients verified to have POTS by positive head-up tilt-testing and cardiovascular autonomic tests, and 65 healthy controls (mean age: 31.1 vs 31.5 years, 84% females) with negative active standing tests and no history of syncope, orthostatic intolerance, or endocrine disease. High-sensitivity chemiluminescence sandwich immunoassay was used to measure plasma levels of inflammatory biomarkers in a blinded fashion. Descriptive statistics compared groups and a univariate ANOVA was employed. Biomarker values were log-transformed. A score incorporating all biomarkers was generated to see if the totality of biomarkers discriminated POTS patients from controls.

Results
Baseline characteristics are displayed in Table 1. Mean levels of GDF15 (p=0.01), NGAL (p=0.003), ICAM-1 (p=0.04) and TNFR1 (p=0.03) were significantly higher in POTS vs controls, whereas TNFR2 (p=0.04) was significantly lower in POTS (p=0.04). The product of four upregulated biomarkers divided by TNFR2 produced a receiver operator curve (ROC) with an area under the curve (AUC) of 0.703 (p
Conclusion
POTS patients had increased GDF15, NGAL, TNFR1 and ICAM-1 levels and reduced TNFR2 levels suggesting underlying, yet undefined, subclinical inflammatory processes involving neutrophil and endothelial activation. (Less)
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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
POTS, biomarkers
in
Europace
pages
345 - 345
publisher
Oxford University Press
conference name
European Heart Rhythm Association (EHRA) Congress 2023
conference location
Barcelona, Spain
conference dates
2023-04-16 - 2023-04-18
ISSN
1532-2092
DOI
10.1093/europace/euad122.225
language
English
LU publication?
yes
id
d482c296-65ad-4758-9b52-552ce3a7add8
date added to LUP
2023-05-28 23:56:31
date last changed
2023-05-30 02:49:15
@misc{d482c296-65ad-4758-9b52-552ce3a7add8,
  abstract     = {{Introduction<br/>Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder characterized by excessive orthostatic tachycardia and orthostatic intolerance. While traditional inflammatory biomarkers tend to be normal, a subclinical inflammatory process may be present in POTS.<br/><br/>Purpose<br/>We aimed to analyse novel inflammatory biomarkers in POTS patients: Growth Differentiation Factor 15 (GDF15), Neutrophil Gelatinase Associated Lipocalin (NGAL), Intercellular Adhesion Molecule 1 (ICAM-1), Tumour Necrosis Factor Receptor 1 (TNFR1) and Tumour Necrosis Factor Receptor 2 (TNFR2) and compared them to healthy controls. These inflammatory biomarkers have been shown to be independent predictors of major adverse cardiovascular events in other populations.<br/><br/>Methods<br/>An age- and sex-matched case-control study included 65 patients verified to have POTS by positive head-up tilt-testing and cardiovascular autonomic tests, and 65 healthy controls (mean age: 31.1 vs 31.5 years, 84% females) with negative active standing tests and no history of syncope, orthostatic intolerance, or endocrine disease. High-sensitivity chemiluminescence sandwich immunoassay was used to measure plasma levels of inflammatory biomarkers in a blinded fashion. Descriptive statistics compared groups and a univariate ANOVA was employed. Biomarker values were log-transformed. A score incorporating all biomarkers was generated to see if the totality of biomarkers discriminated POTS patients from controls.<br/><br/>Results<br/>Baseline characteristics are displayed in Table 1. Mean levels of GDF15 (p=0.01), NGAL (p=0.003), ICAM-1 (p=0.04) and TNFR1 (p=0.03) were significantly higher in POTS vs controls, whereas TNFR2 (p=0.04) was significantly lower in POTS (p=0.04). The product of four upregulated biomarkers divided by TNFR2 produced a receiver operator curve (ROC) with an area under the curve (AUC) of 0.703 (p<br/>Conclusion<br/>POTS patients had increased GDF15, NGAL, TNFR1 and ICAM-1 levels and reduced TNFR2 levels suggesting underlying, yet undefined, subclinical inflammatory processes involving neutrophil and endothelial activation.}},
  author       = {{Nawaz, Sara and Larsson, Anders and Hamrefors, Viktor and Ruge, Toralph and Sutton, Richard and Olshansky, Brian and Fedorowski, Artur and Johansson, Madeleine}},
  issn         = {{1532-2092}},
  keywords     = {{POTS; biomarkers}},
  language     = {{eng}},
  note         = {{Conference Abstract}},
  pages        = {{345--345}},
  publisher    = {{Oxford University Press}},
  series       = {{Europace}},
  title        = {{Novel inflammatory biomarkers in postural orthostatic tachycardia syndrome}},
  url          = {{http://dx.doi.org/10.1093/europace/euad122.225}},
  doi          = {{10.1093/europace/euad122.225}},
  year         = {{2023}},
}