Squatting test: A posture to study and counteract cardiovascular abnormalities associated with autonomic dysfunction

Autonomic Neuroscience: Basic and Clinical

Volumn 162, Issue 1-2, 2011, Pages 3-9

  Philips, Jean Christophe ^a   Scheen, André J ^a  

^a UNIVERSITY OF LIÈGE   (Belgium)

Author keywords

Blood pressure; Cardiovascular autonomic neuropathy; Diabetes; Dysautonomia; Heart rate; Orthostatic hypotension; Squatting; Syncope

Indexed keywords

ARTERIAL OXYGEN SATURATION; AUTONOMIC INNERVATION; AUTONOMIC NEUROPATHY; BLOOD FLOW VELOCITY; BODY POSTURE; BRADYCARDIA; BRAIN BLOOD FLOW; CARDIOVASCULAR AUTONOMIC NEUROPATHY; CYANOTIC HEART DISEASE; DIASTOLIC BLOOD PRESSURE; DISEASE ASSOCIATION; FALLOT TETRALOGY; HEART DENERVATION; HEART GRAFT; HEART OUTPUT; HEART RATE; HEART STROKE VOLUME; HEMODYNAMICS; HUMAN; INSULIN DEPENDENT DIABETES MELLITUS; LUNG BLOOD FLOW; MEAN ARTERIAL PRESSURE; ORTHOSTATIC HYPOTENSION; PRESSORECEPTOR; PRIORITY JOURNAL; PULSE PRESSURE; REVIEW; SQUATTING; SYNCOPE; SYSTOLIC BLOOD PRESSURE; VASCULAR RESISTANCE; VENOUS RETURN;

AUTONOMIC NERVOUS SYSTEM DISEASES; BAROREFLEX; BLOOD PRESSURE; CARDIOVASCULAR PHYSIOLOGICAL PHENOMENA; CYANOSIS; DIABETIC NEUROPATHIES; HEART DEFECTS, CONGENITAL; HEART RATE; HEART TRANSPLANTATION; HUMANS; HYPOTENSION, ORTHOSTATIC; POSTURE; SYNCOPE;

EID: 79958006033     PISSN: 15660702     EISSN: 18727484     Source Type: Journal    
DOI: 10.1016/j.autneu.2011.03.001     Document Type: Review

References (52)

1. Apitz C., Webb G.D., Redington A.N. Tetralogy of Fallot. Lancet 2009, 374:1462-1471.
2. Brotmacher L. Haemodynamic effects of squatting during recovery from exertion. Br. Heart J. 1957, 19:567-573.
3. Chakrabarti S.D., Ganguly R., Chatterjee S.K., Chakravarty A. Is squatting a triggering factor for stroke in Indians?. Acta Neurol Scand. 2002, 105:124-127.
4. Denq J.C., Opfer-Gehrking T.L., Giuliani M., Felten J., Convertino V.A., Low P.A. Efficacy of compression of different capacitance beds in the amelioration of orthostatic hypotension. Clin. Auton. Res. 1997, 7:321-326.
5. Fedorowski A., Stavenow L., Hedblad B., Berglund G., Nilsson P.M., Melander O. Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Preventive Project). Eur. Heart J. 2010, 31:85-91.
6. Freeman R. Clinical practice. Neurogenic orthostatic hypotension. N. Engl. J. Med. 2008, 358:615-624.
7. Grubb B.P., Kosinski D. Tilt table testing: concepts and limitations. Pacing Clin. Electrophysiol. 1997, 20:781-787.
8. Guntheroth W.G., Mortan B.C., Mullins G.L., Baum D. Venous return with knee-chest position and squatting in tetralogy of Fallot. Am. Heart J. 1968, 75:313-318.
9. Hamilton W.F., Winslow J.A., Hamilton W.F. Notes on a case of congenital heart disease with cyanotic episodes. J. Clin. Invest. 1950, 29:20-27.
10. Hanson P., Slane P.R., Tueckert P.A., Clark S.V. Squatting revisited: comparison of haemodynamic responses in normal individuals and heart transplantation recipients. Br. Heart J. 1995, 74:154-158.
11. Hunter W. Three cases of malformation of the heart. Medical Observations and Inquiries by a Society of Physicians in London 1784, 6:291.
12. Imholz B.P., Settels J.J., van der Meiracker A.H., Wesseling K.H., Wieling W. Non-invasive continuous finger blood pressure measurement during orthostatic stress compared to intra-arterial pressure. Cardiovasc. Res. 1990, 24:214-221.
13. Imholz B.P., Wieling W., van Montfrans G.A., Wesseling K.H. Fifteen years experience with finger arterial pressure monitoring: assessment of the technology. Cardiovasc. Res. 1998, 38:605-616.
14. Kim K.H., Cho J.G., Lee K.O., Seo T.J., Shon C.Y., Lim S.Y., Yun K.H., Sohn I.S., Hong Y.J., Park H.W., Kim J.H., Kim W., Ahn Y.K., Jeong M.H., Park J.C., Kang J.C. Usefulness of physical maneuvers for prevention of vasovagal syncope. Circ. J. 2005, 69:1084-1088.
15. Krediet C.T., van Lieshout J.J., Bogert L.W., Immink R.V., Kim Y.S., Wieling W. Leg crossing, muscle tensing, squatting, and the crash position are effective against vasovagal reactions solely through increases in cardiac output. J. Appl. Physiol. 2005, 99:1697-1703.
16. Krediet C.T., Wilde A.A., Halliwill J.R., Wieling W. Syncope during exercise, documented with continuous blood pressure monitoring during ergometer testing. Clin. Auton. Res. 2005, 15:59-62.
17. Krediet C.T., Go-Schön I.K., Kim Y.S., Linzer M., Van Lieshout J.J., Wieling W. Management of initial orthostatic hypotension: lower body muscle tensing attenuates the transient arterial blood pressure decrease upon standing from squatting. Clin. Physiol. Lond. 2007, 113:401-407.
18. Krediet C.T., Go-Schön I.K., van Lieshout J.J., Wieling W. Optimizing squatting as a physical maneuver to prevent vasovagal syncope. Clin. Auton. Res. 2008, 18:179-186.
19. Lahrmann H., Cortelli P., Hilz M., Mathias C.J., Struhal W., Tassinari M. EFNS guidelines on the diagnosis and management of orthostatic hypotension. Eur. J. Neurol. 2006, 13:930-936.
20. Li Q., Zhang J., Li B., Wang W., Liu J., Zhu H., Wang H., Yu S., Cui Q., Sun G., Wu X., Yi D. Pulse oxygen saturation measured in standing and squatting positions may be useful in evaluating tetralogy of Fallot. Heart Surg. Forum 2009, 12:E35-E38.
21. Low P.A., Singer W. Management of neurogenic orthostatic hypotension: an update. Lancet Neurol. 2008, 7:451-458.
22. Lurie P.R. Postural effects in tetralogy of Fallot. Am. J. Med. 1953, 15:297-306.
23. Madden K.M., Tedder G., Lockhart C., Meneilly G.S. Euglycemic hyperinsulinemia alters the response to orthostatic stress in older adults with type 2 diabetes. Diabetes Care 2008, 31:2203-2208.
24. Marfella R., Giugliano D., Di Maro G., Acampora R., Giunta R., D'Onofrio F. The squatting test: a useful tool to assess both parasympathetic and sympathetic involvement of the cardiovascular autonomic neuropathy in diabetes. Diabetes 1994, 43:607-612.
25. Marfella R., Salvatore T., Giugliano D., Di Maro G., Giunta R., Torella R., Juchmes J., Scheen A., Lefèbvre P.J. Detection of early sympathetic cardiovascular neuropathy by squatting test in NIDDM. Diabetes Care 1994, 17:149-151.
26. Maser R.E., Mitchell B.D., Vinik A.I., Freeman R. The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis. Diabetes Care 2003, 26:1895-1901.
27. Medow M.S., Stewart J.M., Sanyal S., Mumtaz A., Sica D., Frishman W.H. Pathophysiology, diagnosis, and treatment of orthostatic hypotension and vasovagal syncope. Cardiol. Rev. 2008, 16:4-20.
28. Morillo C.A., Eckberg D.L., Ellenbogen K.A., Beightol L.A., Hoag J.B., Tahvanainen K.U., Kuusela T.A., Diedrich A.M. Vagal and sympathetic mechanisms in patients with orthostatic vasovagal syncope. Circulation 1997, 96:2509-2513.
29. Morillo C.A., Camacho M.E., Wood M.A., Gilligan D.M., Ellenbogen K.A. Diagnostic utility of mechanical, pharmacological and orthostatic stimulation of the carotid sinus in patients with unexplained syncope. J. Am. Coll. Cardiol. 1999, 34:1587-1594.
30. Murrell C., Cotter J.D., George K., Shave R., Wilson L., Thomas K., Williams M.J., Lowe T., Ainslie P.N. Influence of age on syncope following prolonged exercise: differential responses but similar orthostatic intolerance. J. Physiol. 2009, 587:5959-5969.
31. Nakagawa M., Shinohara T., Anan F., Yufu K., Takahashi N., Okada N., Hara M., Yoshimatsu H., Saikawa T. New squatting test indices are useful for assessing baroreflex sensitivity in diabetes mellitus. Diabet. Med. 2008, 25:1309-1315.
32. Philips J.C., Marchand M., Scheen A.J. Squatting amplifies pulse pressure increase according to duration of type 1 diabetes. Diabetes Care 2008, 31:322-324.
33. Philips J.C., Marchand M., Scheen A.J. Pulse pressure and cardiovascular autonomic neuropathy according to duration of type 1 diabetes. Diab. Metab. Res. Rev. 2009, 25:442-451.
34. Philips J.C., Marchand M., Scheen A.J. Changes in pulse pressure, heart rate and double product during squatting in type 1 diabetes according to age. Diabet. Med. 2010, 27:753-761.
35. Philips J.C., Marchand M., Scheen A.J. Pulsatile stress in middle-aged patients with type 1 or type 2 diabetes compared to nondiabetic controls. Diabetes Care 2010, 33:2424-2429.
36. Raj S.R. Highlights in clinical autonomic neurosciences: orthostatic tachycardia and orthostatic hypotension. Auton. Neurosci. 2010, 154:1-2.
37. Rickards C.A., Newman D.G. A comparative assessment of two techniques for investigating initial cardiovascular reflexes under acute orthostatic stress. Eur. J. Appl. Physiol. 2003, 90:449-457.
38. Rossberg F., Penaz J. Initial cardiovascular response on change of posture from squatting to standing. Eur. J. Appl. Physiol. 1988, 57:93-97.
39. Scheen A.J., Juchmes J., Pochet Th. Non invasive, beat-to-beat, investigation of the effects of posture on arterial blood pressure in diabetic neuropathy. Diab. Metab. 1990, 16:382-384.
40. Schutzman J., Jaeger F., Maloney J., Fouad-Tarazi F. Head-up tilt and hemodynamic changes during orthostatic hypotension in patients with supine hypertension. J. Am. Coll. Cardiol. 1994, 24:454-461.
41. Smit A.A., Wieling W., Fujimura J., Denq J.C., Opfer-Gehrking T.L., Akarriou M., Karemaker J.M., Low P.A. Use of lower abdominal compression to combat orthostatic hypotension in patients with autonomic dysfunction. Clin. Auton. Res. 2004, 14:167-175.
42. Smith J.J., Porth C.M., Erickson M. Hemodynamic response to the upright posture. J. Clin. Pharmacol. 1994, 34:375-386.
43. Somers V.K., Abboud F.M. Neurocardiogenic syncope. Adv. Intern. Med. 1996, 41:399-435.
44. Stewart J.M. Pooling in chronic orthostatic intolerance: arterial vasoconstrictive but not venous compliance defects. Circulation 2002, 105:2274-2281.
45. Stewart J.M., Weldon A. Contrasting neurovascular findings in chronic orthostatic intolerance and neurocardiogenic syncope. Clin. Sci. 2003, 104:329-340.
46. Titianova E., Karakaneva S., Velcheva I. Orthostatic dysregulation in progressive autonomic failure-a transcranial Doppler sonography monitoring. J. Neurol. Sci. 1997, 146:87-91.
47. Tutaj M., Marthol H., Berlin D., Brown C.M., Axelrod F.B., Hilz M.J. Effect of physical countermaneuvers on orthostatic hypotension in familial dysautonomia. J. Neurol. 2006, 253:65-72.
48. van Lieshout J.J., ten Harkel A.D., Wieling W. Physical manoeuvres for combating orthostatic dizziness in autonomic failure. Lancet 1992, 339:897-898.
49. Weimer L.H. Autonomic testing: common techniques and clinical applications. Neurologist 2010, 16:215-222.
50. Wieling W., van Lieshout J.J., van Leeuwen A.M. Physical manoeuvres that reduce postural hypotension in autonomic failure. Clin. Auton. Res. 1993, 3:57-65.
51. Wieling W., Colman N., Krediet C.T., Freeman R. Nonpharmacological treatment of reflex syncope. Clin. Auton. Res. 2004, 14(Suppl 1):62-70.
52. Wieling W., Krediet C.T., van Dijk N., Linzer M., Tschakovsky M.E. Initial orthostatic hypotension: review of a forgotten condition. Clin. Sci. Lond. 2007, 112:157-165.