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Comparative Study
. 2018 Jan;110(1):74-83.
doi: 10.5935/abc.20180003.

Cardiac and Musculoskeletal Responses to the Effects of Passive and Active Tilt Test in Healthy Subjects

[Article in English, Portuguese]
Rogerio Ferreira Liporaci  1 , Marcelo Camargo Saad  1 , Julio César Crescêncio  1 , Fabiana Marques  1 , Debora Bevilaqua-Grossi  1 , Lourenço Gallo-Júnior  1
Affiliations
Comparative Study

Cardiac and Musculoskeletal Responses to the Effects of Passive and Active Tilt Test in Healthy Subjects

[Article in English, Portuguese]
Rogerio Ferreira Liporaci et al. Arq Bras Cardiol. 2018 Jan.

Abstract

Background: Maintenance of orthostatism requires the interaction of autonomic and muscle responses for an efficient postural control, to minimize body motion and facilitate venous return in a common type of syncope called neurocardiogenic syncope (NCS). Muscle activity in standing position may be registered by surface electromyography, and body sway confirmed by displacement of the center of pressure (COP) on a force platform. These peripheral variables reflect the role of muscles in the maintenance of orthostatism during the active tilt test, which, compared with muscle activity during the passive test (head-up tilt test), enables the analyses of electromyographic activity of these muscles that may anticipate the clinical effects of CNS during these tests.

Objective: to evaluate and compare the effects of a standardized protocol of active and passive tests for CNS diagnosis associated with the effects of Valsalva maneuver (VM).

Methods: twenty-thee clinically stable female volunteers were recruited to undergo both tests. EMG electrodes were placed on muscles involved in postural maintenance. During the active test, subjects stood on a force platform. In addition to electromyography and the platform, heart rate was recorded during all tests. Three VMs were performed during the tests.

Results: progressive peripheral changes were observed along both tests, more evidently during the active test.

Conclusion: the active test detected changes in muscle and cardiovascular responses, which were exacerbated by the VM.

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Conflict of interest statement

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Heart rate behavior during the Active Standing Test (AS) and the Head-Up Tilt Test (HUT).⎯: Mean variation of heart rate during AS.⎯: Mean variation of heart rate during AS.🟄: Significant difference between AS and HUT; p < 0.05. Heart rate in beats per minute (bpm).
Figure 2
Figure 2
Total mean velocity on the force platform during the Active Stand Test. A, B, C: significant difference with their corresponding minutes (a, b, c); p < 0,05.
Figure 3
Figure 3
Total displacement on the force platform during the Active Standing Test. A, B, C: significant difference with their corresponding minutes (a,b,c); p < 0.05. TD: Total displacement.
Figure 4
Figure 4
Total displacement variation during the pre-Valsalva maneuver (VM) (1), VM (2) and post-VM (3) periods. Significant values between VM and pre-VM; p < 0.05.
Figure 5
Figure 5
Total mean velocity variation during the pre-Valsalva maneuver (VM) (1), VM (2) and post-VM (3) periods.🟄: Significant values between VM and pre-VM; p < 0.05;ǂ: significant values between post-VM and VM; p < 0.05.
Figure 6
Figure 6
Percentage of maximum effort in relation to the electromyographic activity recorded during the test divided into three stages: pre-Valsalva maneuver (VM), during the VM and post-VM during the Active Standing Test. A, B, C: significant difference with their corresponding muscles (a,b,c): p < 0.05.
Figure 7
Figure 7
Percentage of maximum effort in relation to the electromyographic activity recorded during the test divided into three stages: pre-Valsalva maneuver (VM), during the VM and post-VM during the Head-Up Tilt Test Test. A, B, C: significant difference with their corresponding muscles (a,b,c): p < 0.05.
Figure 8
Figure 8
Comparison of electromyographic activity of all muscles between the Active Standing Test (white) and the Head-Up Tilt Test (grey) during the Pre- Valsalva maneuver (VM) (1), VM (2) and post-VM (3).🟄: p < 0.05.
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