Investigation on the Incidence of Syncope in Children and Adolescents Aged 2-18 Years in Changsha

The relationship between demographic factors and syncopal symptom in pediatric vasovagal syncope

This research proposed to retrospectively analyze 20 years of clinical data and investigate the relationship between demographic factors and syncopal symptom in pediatric vasovagal syncope. A total of 2513 children, 1124 males and 1389 females, age range 3-18 years, who presented to Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University with unexplained syncope or pre-syncope and were diagnosed with vasovagal syncope were retrospectively collected and divided into syncope group (n = 1262) and pre-syncope group (n = 1251). (1) Females had a 36% increased risk of syncope compared to males, a 27% increased risk of syncope for every 1-year increase in age, and a 2% decreased risk of syncope for every 1 cm increase in height. (2) A non-linear relationship between age, height, weight and syncope was observed. When age > 10.67 years, the risk of syncope increases by 45% for each 1-year increase in age; when height < 146 cm, the risk of syncope decreases by 4% for each 1 cm increase in height; when weight < 28.5 kg, the risk of syncope decreases by 10% for each 1 kg increase in weight. Demographic factors are strongly associated with syncopal symptom in pediatric vasovagal syncope and can help to predict the risk.

Calgary score and modified calgary score in the differential diagnosis between syncope and genetic generalized epilepsy in children

The purpose of the study is to explore the use of Calgary scoring (CS) and Modified Calgary scoring (MCS) in the differentiation of genetic generalized epilepsy and syncope in children. The study involved 117 patients aged < 18 years who presented to our hospital's pediatric neurology outpatient clinic with TLOC between June 2020 and June 2022. In addition to CS and MCS scoring, all patients were subjected to statistical analysis based on their age, sex, number of episodes and distribution during the day, duration of syncope, and family history. Seventy-one patients with syncope and 46 with epilepsy were included in the study. At a CS value >  - 1, sensitivity was 86.9% and specificity 63.4%, while at an MCS value >  - 1, sensitivity was 76.1% and specificity 71.8%. CS had less specificity and sensitivity in predicting epilepsy when focal epilepsies were excluded. Abnormal behavior noted by bystanders, including witnessed unresponsive, unusual posturing, or limb jerking? (Q5) emerged as the most important question for the detection of epilepsy. Compared with other syncope findings, loss of consciousness during prolonged sitting or standing (Q9) emerged as the most important for the detection of syncope.

Changes in Blood Pressure Variability in Children with Postural Tachycardia Syndrome

(1) Objective: In this research, we explored the difference in blood pressure variability (BPV) between children with postural tachycardia syndrome (POTS) and healthy children. Furthermore, we tried to investigate the effect of BPV on POTS and its relationship with prognosis of POTS. (2) Methods: 47 children with POTS (11.2 ± 1.8 years, 23 males) were enrolled in the POTS group and 30 healthy children (10.9 ± 1.9 years, 15 males) were matched for the control group. All participants completed 24 h ambulatory blood pressure monitoring (24hABPM). Thirty-three children with POTS were followed up for 52.0 (30.5, 90.5) days and were divided into a response group and a non-response group after evaluation. (3) Results: The 24 h diastolic blood pressure standard deviation (24hDSD), daytime diastolic blood pressure standard deviation (DDSD), nighttime systolic blood pressure standard deviation (NSSD), daytime diastolic blood pressure variation coefficient (DDCV) and nighttime systolic blood pressure variation coefficient (NSCV) in the control group were lower than those in the POTS group (p < 0.05). Percentage of females, age and height were lower in the response group than in the non-response group in children with POTS (p < 0.05). Univariate analysis showed that 24hDSD, DDSD, NSSD, DDCV and NSCV were potential risk factors for POTS, and sex and height were potential risk factors for poor prognosis of POTS. After adjusting for covariates, the risk of POTS increased by 48%, 53% and 49% when DDSD, NSSD and NSCV increased by 1 mmHg, 1 mmHg and 1%, respectively. The risk of poor prognosis in females was 12.99 times higher than that in males. (4) Conclusions: The results suggest that children with POTS may have an abnormal circadian rhythm in blood pressure and increased BPV. DDSD, NSSD and NSCV are independent risk factors for POTS, and being female is an independent risk factor for poor prognosis of POTS.

Development of prognostic nomogram model to predict syncope recurrence in children with vasovagal syncope

Backgrounds

Vasovagal syncope (VVS) is a common form of syncope. In children with VVS, recurrent syncope or presyncope can affect the physical and mental health of both children and parents, which markedly impairs quality of life.

Objectives

We aimed to identify factors at baseline that can predict the recurrence of syncope or presyncope over a 5-year follow-up period, and further to develop a prognostic nomogram model.

Methods

This cohort is bidirectional in design. From July 2017 to August 2022, children with VVS were included and followed up every 3 to 6 months. Head-up Tilt Test (HUTT) was performed for diagnosing VVS. Data were analyzed using STATA software, and risk estimates are presented as hazard ratio (HR) and 95% confidence interval (CI).

Results

Total 352 children with VVS who had complete information were included in this study. Median follow-up time was 22 months. Overall, supine mean arterial pressure (MAP-supine) in HUTT and baseline urine specific gravity (USG) were associated with the significant risk of syncope or presyncope recurrence (HR: 0.70 and 3.00, respectively; both P &lt; 0.05). Calibration and discrimination analyses revealed that the addition of MAP-supine and USG can result in a better fit. A prognostic nomogram model based on significant factors annexed with five traditional promising factors was finally constructed, with strong discriminative and predictive abilities (C-index approaching 0.700, P &lt; 0.05).

Conclusions

Our findings indicated that MAP-supine and USG can independently predict the significant risk of syncope recurrence in children with VVS, and the prediction was more obvious in a nomogram model.

Application of mind map can promote the health education effect of children with vasovagal syncope

Objective

To explore the effect of mind map on health education in children with vasovagal syncope (VVS).

Methods

In this prospective controlled study, 66 children with VVS (29 males, 10.38 ± 1.80 years) and their parents (12 males, 39.27 ± 3.74 years) who were hospitalized in the Department of Pediatrics, The Second Xiangya Hospital, Central South University from April 2020 to March 2021 were set as the control group. 66 children with VVS (26 males, 10.29 ± 1.90 years) and their parents (9 males, 38.65 ± 1.99 years) who were hospitalized in the same hospital from April 2021 to March 2022 were set as the research group. Traditional oral propaganda method was applied in the control group, and the health education method based on mind map was applied in the research group. The self-designed VVS health education satisfaction questionnaire and comprehensive health knowledge questionnaire were used to conduct on-site return visits to the children and their parents who had been discharged from the hospital for 1 month.

Results

There was no significant difference in age, sex, hemodynamic type of VVS, and the parental age, sex, education level between the control group and the research group (P > 0.05). Health education satisfaction score, health education knowledge mastery score, compliance score, subjective efficacy and objective efficacy in the research group were higher than those in the control group (P < 0.05). If the satisfaction score, knowledge mastery score, and compliance score increase by 1 point, the risk of poor subjective efficacy is reduced by 48, 91, and 99%, respectively, and the risk of poor objective efficacy is reduced by 44, 92, and 93%, respectively.

Conclusions

Application of mind map can improve the health education effect of children with VVS.

Knowledge and Awareness of Syncope Among the Population of Riyadh: A Cross-Sectional Study

Background

Although syncope is a common emergency in medical settings, no research has yet evaluated the general population’s awareness regarding it. This study investigated the general population’s knowledge and awareness of syncope and if they could differentiate syncopal and non-syncopal causes of transient loss of consciousness (TLOC).

Methodology

A cross-sectional study was conducted in Riyadh through a validated, self-administered Arabic questionnaire that was distributed to the general population through social media using Google Forms (convenience sampling). Participants younger than 18 or not from Riyadh were excluded from the study. Two cardiologists validated the questionnaire, following which forward and backward translation was done. The questionnaire contained three sections. The first section included demographic data and chronic conditions. In the second section, participants were asked if they or one of their relatives had ever experienced syncope. The third section had eight scenarios assessing the participants’ syncope knowledge. Subjects with ≥five correct answers were considered to be aware.

Results

The number of total responses was 405 participants. Regarding demographic data, 53% of the participants were female, 33% had a medical background, and 76% had a university degree (n = 214, n = 134, and n = 306, respectively). The mean age of the participants was 33.2 ± 13.3 years. Participants who were aware of syncope represented 55% (n = 221). Among the syncope cases, orthostatic syncope had the highest number of correct answers (79%, n = 319), followed by vasovagal syncope (61%, n = 246). Males performed better in cases one (p = 0.001), two (p = 0.004), and seven (p = 0.01).

Conclusions

The results of this study showed that most participants were considered aware of syncope. Gender, marital status, and having a medical background had a significant influence on the results.

Research progress on the predictive value of electrocardiographic indicators in the diagnosis and prognosis of children with vasovagal syncope

Neurally mediated syncope (NMS) is a common type of syncope in children in clinical practice, among which vasovagal syncope (VVS) is the most frequent. In recent years, more and more studies have been carried out to assess the diagnosis and prognosis of VVS. The electrocardiographic indicators such as heart rate variability (HRV), QT dispersion (QTd), P-wave dispersion (Pd), ventricular late potentials (VLP), deceleration ability of heart rate (DC), etc., are easy to obtain and inexpensive. With the help of electrocardiographic indicators, the diagnostic procedure and individualized treatment strategies of pediatric VVS can be optimized. This article reviews the value of electrocardiographic indicators in the diagnosis and prognosis of children with VVS.

The Relationship Between Unexplained Chest Pain in Children and Head-Up Tilt Test

BACKGROUND

To explore the relationship between unexplained chest pain in children and head-up tilt test (HUTT).

MATERIALS AND METHODS

A total of 825 children with the main symptom of unexplained chest pain were admitted to the Specialist Outpatient Clinic of Children's Cardiovascular Disease from October 2000 to November 2021 at The Second Xiangya Hospital, Central South University. Among them, 473 were male and 352 were female, with a mean age of 10.61 ± 2.21 years. The control group included 58 cases, comprising 35 males and 23 females, with a mean age of 10.26 ± 2.66 years. The detailed history, physical examinations, conventional 12-lead electrocardiogram, chest X-ray, echocardiography, myocardial enzymes, electroencephalogram, and blood series were all examined. Disorders of the chest wall, lung, heart, mediastinum, and esophageal reflux, as well as drug effects, were ruled out. All the children underwent HUTT. Demographic description, univariate analysis, and multivariate logistic regression analysis were used to explore the possible linear or non-linear relationships between the children's unexplained chest pain and HUTT.

RESULTS

Among the 825 chest pain cases, 301 (36.48%) were HUTT positive and 524 (63.52%) were HUTT negative. HUTT-positive patients were older than HUTT-negative patients (11.04 ± 2.03 vs. 10.34 ± 2.31 years, P < 0.001). The logistic regression results showed that each year of age increased the probability of being HUTT positive by 17.90% (P < 0.000), and females were 91.30% more likely to be HUTT positive than males (P < 0.000).

CONCLUSION

Clinically unexplained chest pain in children is mainly caused by unbalanced autonomic nervous function. HUTT can help clear the cause of unexplained chest pain.

Prognostic Value of Biomarkers in Children and Adolescents With Orthostatic Intolerance

Orthostatic intolerance (OI) refers to a series of symptoms that occur during upright standing, which can be relieved when returned to the supine position. OI is a common cause of syncope in children and adolescents. In recent years, more and more studies have been carried out to assess the prognosis of OI by using biomarkers, among which, flow-mediated vasodilation, left ventricular ejection fraction and fractional shortening, hemodynamic change during head-up tilt test, detection of 24-h urinary sodium excretion, body mass index, midregional pro-adrenomedullin, and erythrocytic H2S producing rate are relatively stable, inexpensive, and easy to obtain. With the help of biomarkers, individualized treatment can be carried out to improve the long-term prognosis of children and adolescents with OI. This article reviews the prognostic value of biomarkers in children and adolescents with OI.