Baroreflex Sensitivity Predicts Response to Metoprolol in Children With Vasovagal Syncope: A Pilot Study

Tao, Chunyan; Li, Xueying; Tang, Chaoshu; Jin, Hongfang; Du, Junbao

doi:10.3389/fnins.2019.01329

Cited by 12 publications

(13 citation statements)

References 48 publications

(67 reference statements)

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“…The protocol for the HUTT and the positive response criteria were in accordance with those previously described. [ 19 , 20 ] Three types of positive hemodynamic responses were identified according to the changes in heart rate and blood pressure: 1) a cardioinhibitory response, with an obvious reduction in heart rate and no marked decrease in blood pressure; 2) a vasoinhibitory response, with a marked decrease in blood pressure and no obvious reduction in heart rate; and 3) a mixed inhibitory response, with both an obvious blood pressure decrease and a significant heart rate reduction.…”

Section: Methodsmentioning

confidence: 99%

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Body mass index is a promising predictor of response to oral rehydration saline in children with vasovagal syncope

Tao

Chen

et al. 2020

Chinese Medical Journal

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Background: Vasovagal syncope (VVS) greatly impairs quality of life. The therapeutic efficacy of oral rehydration saline (ORS) for unselected VVS patients is not satisfactory due to the diverse mechanisms of the disease. Body mass index (BMI) was demonstrated to reflect blood volume to a certain extent. Therefore, the present study explored the capability of BMI to predict the therapeutic response of children with VVS to ORS treatment. Methods: Seventy-four children with VVS who visited the Syncope Unit of Pediatrics at Peking University First Hospital from November 2010 to June 2019 receiving ORS treatment were enrolled for this retrospective case-control study. A comparison of demographic, clinical, and hemodynamic characteristics was performed between responders and non-responders. The correlation between baseline BMI and response time was analyzed. To determine the value of baseline BMI in predicting the therapeutic efficacy of ORS in children with VVS, a receiver operating characteristic curve analysis was performed. Results: Fifty-two children were identified as responders, and the remaining 22 children were identified as non-responders. The baseline BMI of the responders was much lower than that of the non-responders (16.4 [15.5, 17.8] kg/m 2 vs . 20.7 ±e6 kg/m 2 , P < 0.001), and baseline BMI was positively correlated with response time in the head-up tilt test after adjusting for sex ( r = 0.256, 95% confidence interval [CI]: 0.067–0.439, P = 0.029). The area under the receiver operating characteristic curve of baseline BMI was 0.818 (95% CI: 0.704–0.932, P < 0.001), and an optimal cut-off value of 18.9 kg/m 2 yielded a sensitivity of 83% and a specificity of 73% to predict the efficacy of ORS in VVS. Conclusion: Prior to treatment, baseline BMI is a promising predictor of response to ORS in children with VVS.

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Section: Methodsmentioning

confidence: 99%

“…The therapeutic efficacy was determined to be effective when the symptom score decreased by at least 1 point, and correspondingly, these patients were considered “responders”; otherwise, they were considered “non-responders” [Figure 1 ]. [ 20 , 21 ] All follow-up tasks were completed by the same professionally trained researcher.…”

Section: Methodsmentioning

confidence: 99%

Body mass index is a promising predictor of response to oral rehydration saline in children with vasovagal syncope

Tao

Chen

et al. 2020

Chinese Medical Journal

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“…When CK-MB was 23.94 U/L, the sensitivity and specificity of diagnosing VVS were 71.10 and 66.70%, respectively. Tao et al [ 21 ] reported therapeutic response of baroreflex sensitivity (BRS) in predicting VVS patients to metoprolol, and compared with non-responders, patients with reaction showed a significant increase in BRS value in supine position. When BRS cut-off value was 10 ms/mmHg, the sensitivity and specificity of predicting an intervention response were 82 and 83%.…”

Section: Discussionmentioning

confidence: 99%

The predictive value of urine specific gravity in the diagnosis of vasovagal syncope in children and adolescents

et al. 2021

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Background Vasovagal syncope (VVS) is a kind of common neurally mediated syncope in children and adolescents. Decreased blood volume is one of the pathogenesis of VVS. The diagnosis of VVS is mainly based on head-up tilt test (HUTT), but some complications may easily occur when HUTT induces syncope. To find a simple and safe VVS diagnosis method can improve the VVS diagnosis efficiency. Aims of the study This was a prospective study. The study will explore the predictive value of urine specific gravity (USG) in the diagnosis of VVS in children and adolescents. Patients and methods Ninety-seven cases (43 males and 54 females, aged 4 to 16 years old, with an average age of 10.91 ± 2.18 years old) hospitalized due to unexplained premonitory syncope or syncope and diagnosed with VVS through HUTT from September 2014 to September 2018 were selected as VVS group. During the same period, 91 cases of children and adolescents, including 45 males and 46 females, aged from 5 to 15 years old, who underwent a healthy examination were matched as a control (control group). USG was measured in both groups. Results The USG of VVS group was significantly lower than that of the control group (P < 0.01), and USG of females was lower than that of males in VVS group (P = 0.045). The sensitivity and specificity of USG in predicting VVS were evaluated by ROC curve. The area under the ROC curve was 0.751, standard error was 0.035, and 95% CI (0.683, 0.819) suggested that USG was of moderate predictive value in the diagnosis of VVS. As cut-off value of USG was 1.0185, the sensitivity and specificity and diagnostic coincidence rate of VVS were 74.39, 66.04 and 69.68%, respectively. Conclusion There are less USG in children and adolescents with VVS, especially lower USG in females. Therefore, USG has predictive value in the diagnosis of VVS in children and adolescents.

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“… 1 The severity of the disease was assessed by the syncope symptom score based on the frequency of syncope episodes. 29 , 46 , 47 The syncope symptom score was as follows: 0, no syncope; 1, once/month; 2, two to four times/month; 3, two to seven times/week; 4, more than once per day. 29 , 30 , 46 , 47 The baseline syncope symptom score was evaluated by the average frequency of syncope episodes within 3 months before metoprolol treatment.…”

Section: Methodsmentioning

confidence: 99%

“… 29 , 46 , 47 The syncope symptom score was as follows: 0, no syncope; 1, once/month; 2, two to four times/month; 3, two to seven times/week; 4, more than once per day. 29 , 30 , 46 , 47 The baseline syncope symptom score was evaluated by the average frequency of syncope episodes within 3 months before metoprolol treatment. After 3 months of metoprolol treatment, all the patients were followed up by hospitalization, outpatient clinics or telephone, and their frequency of syncope episodes during the metoprolol treatment and the treatment compliance were collected, recorded, and checked by professional investigators.…”

Section: Methodsmentioning

confidence: 99%

Poincaré Plot Can Be a Useful Tool to Select Potential Responders to Metoprolol Therapy in Children with Vasovagal Syncope

Yuan¹,

Li²,

Tao³

et al. 2022

IJGM

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Purpose To explore the value of the longitudinal axis/transverse axis ratio (L/T) of Poincaré plot in selecting children with vasovagal syncope (VVS) who were suitable for metoprolol therapy. Patients and Methods Children with VVS hospitalized in Peking University First Hospital between January 2012 and June 2019 and treated with metoprolol were retrospectively included as the training set, and children with VVS hospitalized between July 2019 and December 2020 were included as the validation set. The sex, age at admission, height, weight, body mass index, course of disease, syncope symptom score before metoprolol treatment, treatment duration, supine heart rate (HR), supine systolic pressure, supine diastolic pressure, peak HR during the head-up tilt test (HUTT), changes of HR during HUTT, hemodynamic response during HUTT, left ventricular ejection fraction, left ventricular fractional shortening and the L/T of Poincaré plot were compared between responders and nonresponders in the training set. Logistic regression analysis was conducted to explore predictors. Receiver operating characteristic curve was utilized to determine the value of the predictors for selecting potential responders. Finally, the value of the predictors was further verified. Results In the training set including 105 children, the L/T in responders was distinctly higher than that in nonresponders (P < 0.001), and there was no apparent difference between the two groups in other indexes. The L/T was statistically related to the efficacy of metoprolol (P < 0.001). The L/T >2.7 yielded a sensitivity of 88.2% and a specificity of 82.8% for indicating responders to metoprolol. Taking L/T >2.7 to select potential responders in another 43 children with VVS in the validation set, the sensitivity was 96.6%, specificity 71.4%, and accuracy 88.4%. Conclusion The L/T of Poincaré plot >2.7 can be a useful tool to select potential responders to metoprolol therapy in children with VVS.

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Baroreflex Sensitivity Predicts Response to Metoprolol in Children With Vasovagal Syncope: A Pilot Study

Cited by 12 publications

References 48 publications

Body mass index is a promising predictor of response to oral rehydration saline in children with vasovagal syncope

Body mass index is a promising predictor of response to oral rehydration saline in children with vasovagal syncope

The predictive value of urine specific gravity in the diagnosis of vasovagal syncope in children and adolescents

Poincaré Plot Can Be a Useful Tool to Select Potential Responders to Metoprolol Therapy in Children with Vasovagal Syncope

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