1
|
Wang J, Liu X, Jin H, Du J. Markers for predicting the efficacy of beta-blockers in vasovagal syncope management in children: A mini-review. Front Cardiovasc Med 2023; 10:1131967. [PMID: 36970341 PMCID: PMC10030864 DOI: 10.3389/fcvm.2023.1131967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
Vasovagal syncope (VVS) is a common subtype of neurally mediated syncope. It is prevalent in children and adolescents, and critically affects the quality of life of patients. In recent years, the management of pediatric patients with VVS has received extensive attention, and β-blocker serves as an important choice of the drug therapy for children with VVS. However, the empirical use of β-blocker treatment has limited therapeutic efficacy in patients with VVS. Therefore, predicting the efficacy of β-blocker therapy based on biomarkers related to the pathophysiological mechanism is essential, and great progress has been made by applying these biomarkers in formulating individualized treatment plans for children with VVS. This review summarizes recent advances in predicting the effect of β-blockers in the management of VVS in children.
Collapse
Affiliation(s)
- Jing Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xueqin Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Correspondence: Junbao Du Hongfang Jin Xueqin Liu
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Correspondence: Junbao Du Hongfang Jin Xueqin Liu
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China
- Correspondence: Junbao Du Hongfang Jin Xueqin Liu
| |
Collapse
|
2
|
Miranda CM, da Silva RMFL, Peruhybe-Magalhães V, Brugada J. Vasoactive Biomarkers in Patients With Vasovagal Syncope During Head-Up Tilt Test: A Case-Control Study. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2022; 16:11795468221116848. [PMID: 36046183 PMCID: PMC9421056 DOI: 10.1177/11795468221116848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
Abstract
Background: Vasovagal syncope (VVS) is the most common cause of syncope. Some stages of its pathophysiological mechanisms remain unclear. Vasoactive substances such as nitric oxide metabolites (NOx) and endothelin (ET) may be involved during acute orthostatic stress. Objective: To analyze plasma changes in NOx and ET and heart rate variability (HRV) in the supine positions (T1) and during the head-up tilt test (HUTT) (T2), in patients with VVS (case group) and control group. Methods: Thirty-seven patients (17 in the case group and 20 in the control group), matched for age and sex (mean aged 31.8 years) underwent HUTT with simultaneous HRV recording and venipuncture. Blood samples were collected during phases T1 and T2 and the analysis was performed without knowledge of the HUTT result. Results: In the total sample, there was an increase in NOx values (P = .014), however there was no increase in ET values from phase T1 to phase T2. Patients with VVS tended to increase plasma NOx values (P = .057) and had significantly higher plasma values compared to ET (P = .033) between phases T1 to T2. In the control group, there was no significant change in the values of these vasoactive substances. Regarding HRV, there were a decrease in the component HF (high frequency) and increased of the LF (low frequency)/HF ratio during HUTT. Conclusions: There was an increase in ET during HUTT occurred only in the case group. These patients are more likely to have an imbalance between antagonistic vasoactive biomarkers during orthostatic stress.
Collapse
Affiliation(s)
- Cláudia Madeira Miranda
- Faculty of Medicine, Federal University of Minas Gerais, Brazil.,Madre Teresa Hospital, Minas Gerais, Brazil
| | | | | | - Josep Brugada
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
3
|
Tao C, Cui Y, Zhang C, Liu X, Zhang Q, Liu P, Wang Y, Du J, Jin H. Clinical Efficacy of Empirical Therapy in Children with Vasovagal Syncope. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1065. [PMID: 35884049 PMCID: PMC9315970 DOI: 10.3390/children9071065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022]
Abstract
(1) Background: This case-control study was designed to assess the efficacy of empiric treatment for vasovagal syncope in children; (2) Methods: We retrospectively enrolled 181 children with vasovagal syncope from the Department of Pediatrics of Peking University First Hospital. The participants were categorized into four groups, based on the empiric treatment received: conventional treatment, including health education and orthostatic training; conventional treatment plus oral rehydration salts; conventional treatment plus metoprolol; conventional treatment plus midodrine hydrochloride. Patients were followed up to evaluate the syncopal or presyncopal recurrence. Kaplan-Meier curves were drawn to explore the syncopal or presyncopal recurrence in children, and the differences were compared among the groups using a log-rank test; (3) Results: Among the 181 children with vasovagal syncope, 11 were lost to follow-up. The median time of follow-up was 20 (8, 42) months. The Kaplan-Meier survival curve showed no significant difference in syncopal or presyncopal recurrence in children treated with different empiric options according to a log-rank test (χ2 = 1.328, p = 0.723); (4) Conclusions: The efficacy of unselected empiric therapy of vasovagal syncope in children was limited, and the individualized therapies merit further studies.
Collapse
Affiliation(s)
- Chunyan Tao
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
- Department of Genetics and Endocrinology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Yaxi Cui
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
| | - Chunyu Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
| | - Xueqin Liu
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
| | - Qingyou Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
| | - Ping Liu
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
| | - Yuli Wang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
- Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing 100191, China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
| |
Collapse
|
4
|
Advance in the understanding of vasovagal syncope in children and adolescents. World J Pediatr 2021; 17:58-62. [PMID: 32405708 DOI: 10.1007/s12519-020-00367-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Vasovagal syncope (VVS) accounts for 60-80% of cases of neurally mediated syncope. VVS results from acute orthostatic intolerance and recurrent syncopal attacks, which can seriously affect an individual's quality of life. In addition, some children even experience trauma during attacks. Therefore, it is particularly important to clarify the pathogenesis of VVS. The aim of our study is to reveal the latest research progress of VVS. DATA SOURCES Literature that involved the pathogenesis of VVS were selected from Cochrane Library (1990-2019), EMBASE (1991-2019) and PubMed (1968-2019) databases. RESULTS Hypovolemia, autonomic dysfunction, vasomotor dysfunction, baroreceptor reflex abnormalities, endothelial dysfunction, serotonin surges, and gut microbiota were involved in the underlying mechanism of VVS. CONCLUSIONS VVS is not always a benign prognosis. Various aspects were involved in its pathogenesis. Bezold-Jarish reflex, dysfunction of the autonomic nervous system, genetic factors and so on played important roles in VVS; however, the mechanism remains unclear.
Collapse
|
5
|
Chen G, Du J, Jin H, Huang Y. Postural Tachycardia Syndrome in Children and Adolescents: Pathophysiology and Clinical Management. Front Pediatr 2020; 8:474. [PMID: 32974246 PMCID: PMC7468430 DOI: 10.3389/fped.2020.00474] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 07/06/2020] [Indexed: 12/21/2022] Open
Abstract
Postural tachycardia syndrome (POTS), characterized by chronic (≥6 months) orthostatic intolerance symptoms with a sustained and excessive heart rate increase while standing without postural hypotension, is common in children and adolescents. Despite the unclear pathogenesis of POTS, the present opinion is that POTS is a heterogeneous and multifactorial disorder that includes altered central blood volume, abnormal autonomic reflexes, "hyperadrenergic" status, damaged skeletal muscle pump activity, abnormal local vascular tension and vasoactive factor release, mast cell activation, iron insufficiency, and autoimmune dysfunction. A number of pediatric POTS patients are affected by more than one of these pathophysiological mechanisms. Therefore, individualized treatment strategies are initiated in the management of POTS, including basal non-pharmacological approaches (e.g., health education, the avoidance of triggers, exercise, or supplementation with water and salt) and special pharmacological therapies (e.g., oral rehydration salts, midodrine hydrochloride, and metoprolol). As such, the recent progress in the pathogenesis, management strategies, and therapeutic response predictors of pediatric POTS are reviewed here.
Collapse
Affiliation(s)
- Guozhen Chen
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Department of Pediatrics, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
- Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Science, The Ministry of Education, Beijing, China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yaqian Huang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| |
Collapse
|
6
|
Tao C, Lu W, Lin J, Li H, Li X, Tang C, Du J, Jin H. Long-Term Outcomes of Children and Adolescents With Postural Tachycardia Syndrome After Conventional Treatment. Front Pediatr 2019; 7:261. [PMID: 31316954 PMCID: PMC6610301 DOI: 10.3389/fped.2019.00261] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/07/2019] [Indexed: 11/13/2022] Open
Abstract
Objectives: To explore the long-term outcomes of children and adolescents with postural tachycardia syndrome receiving conventional interventions. Materials and Methods: A total of 121 patients were recruited, but 6 (5.0%) of them were lost at follow-up. The detailed clinical data were collected, and the reoccurrence and frequency of orthostatic intolerance symptoms were evaluated with a mean followed-up period of 18.7 months (range, 14-74 months). The Kaplan-Meier curve was used to show the cumulative symptom-free rate of patients over time. Factors influencing the long-term outcomes were examined using the Cox's proportional hazards models. Results: The cumulative symptom-free rate was gradually increased over time. It was 48.4% at the 1-year follow-up and increased to 85.6% at the 6-year follow-up. The duration of symptoms before treatment and the maximum upright heart rate in standing-up test were identified as independent indicators for the long-term outcomes. Each 1-month prolongation in the duration of symptoms before treatment was associated with a 1.2% decrease in the cumulative symptom-free rate. However, each 1-bpm increase in the maximum upright heart rate in standing-up test was associated with a 2.1% increase in the cumulative symptom-free rate. Conclusions: The long-term outcomes of postural tachycardia syndrome patients who received conventional interventions are benign and the cumulative symptom-free rate was gradually increased over time. The prolonged duration of symptoms before treatment and the reduced maximum upright heart rate in standing-up test are the independent risk indicators.
Collapse
Affiliation(s)
- Chunyan Tao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Wenxin Lu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jing Lin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Hongxia Li
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xueying Li
- Department of Medical Statistics, Peking University First Hospital, Beijing, China
| | - Chaoshu Tang
- Department of Physiology and Pathophysiology, Peking University Health Science Center, Beijing, China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Science, The Ministry of Education, Beijing, China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| |
Collapse
|
7
|
Tao CY, Li HX, Li XY, Tang CS, Jin HF, DU JB. [Hemodynamic changes in standing-up test of children and adolescents with postural tachycardia syndrome]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:414-421. [PMID: 31209411 DOI: 10.19723/j.issn.1671-167x.2019.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore the hemodynamic changes in standing-up test of children and adolescents with postural tachycardia syndrome (POTS) and to compare hemodynamic parameters of POTS patients with decreased cardiac index (CI) and those with not-decreased CI. METHODS A retrospective study was conducted to show the trends of CI, total peripheral vascular resistance index (TPVRI), heart rate and blood pressure in standing-up test of 26 POTS patients and 12 healthy controls, and to compare them between the two groups. The POTS patients were divided into two groups based on CI decreasing or not in standing-up test, namely decreased CI group (14 cases) and not-decreased CI group (12 cases). The trends of the above mentioned hemodynamic parameters in standing-up test were observed and compared between decreased CI group and not-decreased CI group. RESULTS In standing-up test for all the POTS patients, CI (F=6.936, P=0.001) and systolic blood pressure (F=6.049, P<0.001) both decreased significantly, and heart rate increased obviously (F=113.926, P<0.001). However, TPVRI (F=2.031, P=0.138) and diastolic blood pressure (F=2.018, P=0.113) had no significant changes. For healthy controls, CI (F=3.646, P=0.016), heart rate (F=43.970, P<0.001), systolic blood pressure (F=4.043, P=0.020) and diastolic blood pressure (F=8.627, P<0.001) all increased significantly in standing-up test. TPVRI (F=1.688, P=0.190) did not change obviously. The changing trends of CI (F=6.221, P=0.001), heart rate (F=6.203, P<0.001) and systolic blood pressure (F=7.946, P<0.001) over time were significantly different between the patients and healthy controls, however, no difference was found in TPVRI and diastolic blood pressure (P > 0.05). Among the POTS patients, CI was significantly different between decreased CI group and not-decreased CI group (F=14.723, P<0.001). Systolic blood pressure of the former decreased obviously (F=8.010, P<0.001), but it did not change obviously in the latter (F=0.612, P=0.639). Furthermore, none of the changes of TPVRI, heart rate and diastolic blood pressure in standing-up test were significantly different between the two groups (P > 0.05). Age was an independent factor for decreased CI patients (P=0.013, OR=2.233; 95% CI, 1.183 to 4.216). CONCLUSION POTS patients experience vital hemodynamic changes in standing-up test, part of them suffering from decreased CI, but others from not-decreased CI. Age is an independent factor for patients suffering from decreased CI.
Collapse
Affiliation(s)
- C Y Tao
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - H X Li
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - X Y Li
- Department of Statistics, Peking University First Hospital, Beijing 100034, China
| | - C S Tang
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Beijing 100191, China
| | - H F Jin
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - J B DU
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China.,Key Laboratory of Molecular Cardiovascular Science, the Ministry of Education, Beijing 100191, China
| |
Collapse
|
8
|
Xu W, Wang T. Diagnosis and treatment of syncope in pediatric patients: a new guideline. Sci Bull (Beijing) 2019; 64:357-358. [PMID: 36659720 DOI: 10.1016/j.scib.2019.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Wenrui Xu
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Tianyou Wang
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
| |
Collapse
|
9
|
2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents. Sci Bull (Beijing) 2018; 63:1558-1564. [PMID: 36751076 DOI: 10.1016/j.scib.2018.09.019] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 01/12/2023]
Abstract
Syncope belongs to the transient loss of consciousness (TLOC), characterized by a rapid onset, short duration, and spontaneous complete recovery. It is common in children and adolescents, accounting for 1% to 2% of emergency department visits.Recurrent syncope can seriously affect children's physical and mental health, learning ability and quality of life and sometimes cardiac syncope even poses a risk of sudden death. The present guideline for the diagnosis and treatment of syncope in children and adolescents was developed for guiding a better clinical management of pediatric syncope. Based on the globally recent development and the evidence-based data in China, 2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents was jointly prepared by the Pediatric Cardiology Society, Chinese Pediatric Society, Chinese Medical Association (CMA)/Committee on Pediatric Syncope, Pediatricians Branch, Chinese Medical Doctor Association (CMDA)/Committee on Pediatric Cardiology, Chinese College of Cardiovascular Physicians, Chinese Medical Doctor Association (CMDA)/Pediatric Cardiology Society, Beijing Pediatric Society, Beijing Medical Association (BMA). The present guideline includes the underlying diseases of syncope in children and adolescents, the diagnostic procedures, methodology and clinical significance of standing test and head-up tilt test, the clinical diagnosis vasovagal syncope, postural orthostatic tachycardia syndrome, orthostatic hypotension and orthostatic hypertension, and the treatment of syncope as well as follow-up.
Collapse
|
10
|
Li H, Liao Y, Han Z, Wang Y, Liu P, Zhang C, Tang C, Du J, Jin H. Head-up tilt test provokes dynamic alterations in total peripheral resistance and cardiac output in children with vasovagal syncope. Acta Paediatr 2018; 107:1786-1791. [PMID: 29603793 DOI: 10.1111/apa.14342] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/26/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Abstract
AIM This study examined the total peripheral vascular resistance (TPVR) and cardiac output changes due to the head-up tilt test (HUTT) in children with vasovagal syncope (VVS). METHODS From December 2013 to January 2016, we recruited 77 children diagnosed with VVS group at Peking University First Hospital, China, and 28 children without VVS provided the control group. Heart rate, blood pressure, TPVR, cardiac output and baroreflex sensitivity were monitored during the HUTT. RESULTS In the supine position, TPVR and baroreflex sensitivity were higher in the patients with VVS than the controls, but cardiac output did not differ between the two groups. There were obvious increases in the VVS patients from TPVR in the supine position to the prepositive response period (p < 0.05), then the positive response period (p < 0.01). However, we noted the opposite trend in cardiac output, from the supine position to the prepositive response period (p < 0.01) then the positive response period (p < 0.01). CONCLUSION During HUTT, children with VVS demonstrated increases in TPVR but decreases in cardiac output, during the transition from the supine position to the positive response. This response might be involved in the pathogenesis of VVS.
Collapse
Affiliation(s)
- Hongxia Li
- Department of Pediatrics; Peking University First Hospital; Beijing China
| | - Ying Liao
- Department of Pediatrics; Peking University First Hospital; Beijing China
| | | | - Yuli Wang
- Department of Pediatrics; Peking University First Hospital; Beijing China
| | - Ping Liu
- Department of Pediatrics; Peking University First Hospital; Beijing China
| | - Chunyu Zhang
- Department of Pediatrics; Peking University First Hospital; Beijing China
| | - Chaoshu Tang
- Department of Physiology and Pathophysiology; Peking University Health Sciences Centre; Beijing China
| | - Junbao Du
- Department of Pediatrics; Peking University First Hospital; Beijing China
| | - Hongfang Jin
- Department of Pediatrics; Peking University First Hospital; Beijing China
| |
Collapse
|
11
|
Left Ventricular Ejection Fraction and Fractional Shortening are Useful for the Prediction of the Therapeutic Response to Metoprolol in Children with Vasovagal Syncope. Pediatr Cardiol 2018; 39:1366-1372. [PMID: 29767293 DOI: 10.1007/s00246-018-1904-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 05/08/2018] [Indexed: 01/11/2023]
Abstract
The objective of this manuscript was to explore if left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) could predict the efficacy of metoprolol therapy on vasovagal syncope (VVS) in children. Forty-nine children, including 30 with VVS and 19 gender- and age-matched healthy controls, were included in the study. Metoprolol was prescribed to the VVS subjects. The clinical data were obtained during follow-up at 2 and 6 months. The results showed that LVEF and LVFS of responders were significantly higher than those of non-responders both at the 2-month follow-up (LVEF: 72.5 ± 3.2% vs. 64.6 ± 3.4%; LVFS: 40.9 ± 2.3% vs. 34.9 ± 2.9%), and at the 6-month follow-up (LVEF: 72.8 ± 2.8% vs. 65.5 ± 4.6%; LVFS: 41.1 ± 1.9% vs. 35.8 ± 3.6%). The receiver operating characteristic curve (ROC) analysis demonstrated that 70.5% as a cutoff value of baseline LVEF yielded a sensitivity of 80% and a specificity of 100% in predicting the therapeutic effectiveness of metoprolol at 2 months. For baseline LVFS, 38.5% as a cutoff value yielded a sensitivity of 90% and a specificity of 90%. At the 6-month follow-up, the ROC analysis demonstrated that 70.5% as a cutoff value of baseline LVEF yielded a sensitivity of 81.3% and a specificity of 88.9% in the prediction of metoprolol efficacy. For baseline LVFS, 37.5% as a cutoff value yielded a sensitivity of 93.8% and a specificity of 66.7%. In conclusion, baseline LVEF and LVFS might be useful predictors of the efficacy of β-blocker therapy on VVS in children.
Collapse
|
12
|
Li H, Liao Y, Wang Y, Liu P, Sun C, Chen Y, Tang C, Jin H, Du J. Baroreflex Sensitivity Predicts Short-Term Outcome of Postural Tachycardia Syndrome in Children. PLoS One 2016; 11:e0167525. [PMID: 27936059 PMCID: PMC5147897 DOI: 10.1371/journal.pone.0167525] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/15/2016] [Indexed: 11/19/2022] Open
Abstract
Objective The study was designed to examine if baroreflex sensitivity (BRS) could predict the short-term outcome of postural tachycardia syndrome (POTS) in children. Methods Seventy-seven children subjects were included in the study. Among them, 45 children were in the POTS group and another 32 healthy children were in the control group. A ninety-day clinical follow-up was conducted and the symptom score before and after the follow-up was calculated for POTS patients by using POTS score system. Hemodynamics and continuous BRS monitoring were recorded by Finapres Medical System-FMS (FinometerPRO, FMS Company, Netherlands). According to the symptom score change during follow-up period, POTS patients were further divided into subgroup A (n = 24) with symptom score decreased by at least two points and subgroup B (n = 21) with symptom score decreased by less than two points. The predictive value of BRS in the short-term outcome of POTS in children was analyzed using receiver-operating characteristic (ROC) curve. Results BRS of POTS children was significantly higher than that of the healthy children (18.76±9.96 ms/mmHg vs 10±5.42 ms/mmHg, P<0.01). It was higher in subgroup B than that of subgroup A (24.7±9.9 ms/mmHg vs 13.5±6.6 ms/mmHg, P <0.01). BRS was positively correlated with HR change in POTS Group (r = 0.304, P <0.05). Area under curve (AUC) was 0.855 (95% of confidence interval 0.735–0.975), and BRS of 17.01 ms/mmHg as a cut-off value yielded the predictive sensitivity of 85.7% and specificity of 87.5%. Conclusions BRS is a useful index to predict the short-term outcome of POTS in children.
Collapse
Affiliation(s)
- Hongxia Li
- Department of Pediatrics, Peking University First Hospital, Beijing, P. R. China
| | - Ying Liao
- Department of Pediatrics, Peking University First Hospital, Beijing, P. R. China
| | - Yuli Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, P. R. China
| | - Ping Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, P. R. China
| | - Chufan Sun
- Department of Pediatrics, Peking University First Hospital, Beijing, P. R. China
| | - Yonghong Chen
- Department of Pediatrics, Peking University First Hospital, Beijing, P. R. China
| | - Chaoshu Tang
- Department of Physiology and Pathophysiology, Peking University Health Sciences Centre, Beijing, P. R. China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, P. R. China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, P. R. China
- Key Laboratory of Cardiovascular Sciences, Ministry of Education, Beijing, P. R. China
- * E-mail:
| |
Collapse
|