Hemodynamic profile and heart rate variability in hyperadrenergic versus non-hyperadrenergic postural orthostatic tachycardia syndrome

Crnošija, Luka; Skorić, Magdalena Krbot; Adamec, Ivan; Lovrić, Mila; Junaković, Anamari; Mišmaš, Antonija; Miletić, Vesna; Alfirev, Rujana Šprljan; Pavelić, Antun; Habek, Mario

doi:10.1016/j.clinph.2015.08.015

Cited by 10 publications

(7 citation statements)

References 25 publications

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“…In order to test the hypothesis, we pooled patients from group A and B into a POTS group and patients from group C and D into a non-POTS group according to their symptoms 12…”

Section: Methodsmentioning

confidence: 99%

Effect of Food Intake on Hemodynamic Parameters during the Tilt-Table Test in Patients with Postural Orthostatic Tachycardia Syndrome

et al. 2019

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Background and Purpose The aim of this study was to determine the effect of food intake on the heart rate (HR) in postural orthostatic tachycardia syndrome (POTS). Methods The following five-phase protocol was applied to 41 subjects who had a sustained HR increment of ≥30 beats/min within 10 min of standing in an initial tilt-table test: 1) 10-min supine phase, 2) 10-min 70°-tilted phase, 3) ingestion of 400 mL of Nutridrink Multi Fibre®, 4) 45-min supine phase, and 5) 10-min 70°-tilted phase. Subjects were divided into four groups: A) difference in HR for standing vs. supine (ΔHR) before the meal of ≥30 beats/min ( n =13), B) ΔHR <30 beats/min before the meal but ≥30 beats/min after the meal ( n =12), and C) ΔHR <30 beats/min both before and after the meal ( n =16). Group D consisted of 10 healthy subjects. Results Before the meal, ΔHR was significantly higher in group A than in all of the other groups, and in group B than in group D ( p <0.001). After the meal, ΔHR was significantly higher in groups A and B ( p <0.001 and p <0.0001, respectively). When we pooled patients (according to their symptoms) from group A and B into a POTS group and from group C and D into a non-POTS group, an increase in HR of 25 beats/min before the meal had a sensitivity of 92.0% and a specificity of 80.8%. After the meal, an increase in HR of 30 beats/min had a sensitivity of 96.0% and a specificity of 96.2%. Conclusions Food intake can significantly alter the results of the tilt-table test and so should be taken into account when diagnosing POTS.

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“…In order to test the hypothesis, we pooled patients from group A and B into a POTS group and patients from group C and D into a non-POTS group according to their symptoms 12…”

Section: Methodsmentioning

confidence: 99%

Effect of Food Intake on Hemodynamic Parameters during the Tilt-Table Test in Patients with Postural Orthostatic Tachycardia Syndrome

et al. 2019

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“…Recently, Zhang et al revealed that baseline norepinephrine was remarkably elevated among some cases with POTS, depicting a positive relationship with the severity of clinical manifestations [ 7 ]. In addition, the norepinephrine elimination mechanism is impaired among POTS patients with significant sympathetic activation [ 28 , 29 ]. Therefore, attention has been given to the role of hyperadrenaline status in developing POTS.…”

Section: Discussionmentioning

confidence: 99%

A predictive model of response to metoprolol in children and adolescents with postural tachycardia syndrome

Zhang

et al. 2023

World J Pediatr

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Background The present work was designed to explore whether electrocardiogram (ECG) index-based models could predict the effectiveness of metoprolol therapy in pediatric patients with postural tachycardia syndrome (POTS). Methods This study consisted of a training set and an external validation set. Children and adolescents with POTS who were given metoprolol treatment were enrolled, and after follow-up, they were grouped into non-responders and responders depending on the efficacy of metoprolol. The difference in pre-treatment baseline ECG indicators was analyzed between the two groups in the training set. Binary logistic regression analysis was further conducted on the association between significantly different baseline variables and therapeutic efficacy. Nomogram models were established to predict therapeutic response to metoprolol. The receiver-operating characteristic curve (ROC), calibration, and internal validation were used to evaluate the prediction model. The predictive ability of the model was validated in the external validation set. Results Of the 95 enrolled patients, 65 responded to metoprolol treatment, and 30 failed to respond. In the responders, the maximum value of the P wave after correction (Pcmax), P wave dispersion (Pd), Pd after correction (Pcd), QT interval dispersion (QTd), QTd after correction (QTcd), maximum T-peak-to-T-end interval (Tpemax), and T-peak-to-T-end interval dispersion (Tped) were prolonged (all P < 0.01), and the P wave amplitude was increased (P < 0.05) compared with those of the non-responders. In contrast, the minimum value of the P wave duration after correction (Pcmin), the minimum value of the QT interval after correction (QTcmin), and the minimum T-peak-to-T-end interval (Tpemin) in the responders were shorter (P < 0.01, < 0.01 and < 0.01, respectively) than those in the non-responders. The above indicators were screened based on the clinical significance and multicollinearity analysis to construct a binary logistic regression. As a result, pre-treatment Pcmax, QTcmin, and Tped were identified as significantly associated factors that could be combined to provide an accurate prediction of the therapeutic response to metoprolol among the study subjects, yielding good discrimination [area under curve (AUC) = 0.970, 95% confidence interval (CI) 0.942–0.998] with a predictive sensitivity of 93.8%, specificity of 90.0%, good calibration, and corrected C-index of 0.961. In addition, the calibration curve and standard curve had a good fit. The accuracy of internal validation with bootstrap repeated sampling was 0.902. In contrast, the kappa value was 0.769, indicating satisfactory agreement between the predictive model and the results from the actual observations. In the external validation set, the AUC for the prediction model was 0.895, and the sensitivity and specificity were 90.9% and 95.0%, respectively. Conclusions A high-precision predictive model was successfully developed and externally validated. It had an excellent predictive value of the therapeutic effect of metoprolol on POTS among children and adolescents.

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“…Earlier studies reported that mutation of norepinephrine transporter (NET) might be one of the reasons for the elevated norepinephrine level (26). Other than that, the clearance mechanism of norepinephrine in POTS patients is damaged and their sympathetic activation is prominent (27, 28).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of β-Blockers on Postural Tachycardia Syndrome in Children and Adolescents: A Systematic Review and Meta-Analysis

et al. 2019

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Background: Postural tachycardia syndrome (POTS) is a severe health problem in children. Short-term β-blockers are recommended for pharmaceutical treatment. However, there have been contradictory data about its efficacy among pediatric patients.Methods and Results: Eight studies comparing β-blockers to conventional treatments for children with POTS were selected, where 497 cases of pediatric POTS were included. The efficacy of β-blockers was evaluated using the effective rate, the change of symptom score, the change of heart rate difference and adverse events. The results were stated as relative ratio (RR) and mean difference (MD) with a 95% confidence interval (95% CI). A random-effects meta-analysis for the effective rate indicated that β-blockers were more effective in treating pediatric POTS than controlled treatment (79.5 vs. 57.3%, RR = 1.50, 95%CI: 1.15–1.96, P < 0.05). A fixed-effects model analysis showed that β-blockers were more effective in lowering the symptom score and the heart rate increment during standing test than controlled treatment with a mean difference of 0.81 (95% CI: 0.44–1.18, P < 0.05) and 3.78 (95% CI: 2.10–5.46, P < 0.05), respectively. There were no reported severe adverse events in included studies.Conclusion: β-blockers are effective in treating POTS in children and adolescents, alleviating orthostatic intolerance, and improving hemodynamic abnormalities.

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Hemodynamic profile and heart rate variability in hyperadrenergic versus non-hyperadrenergic postural orthostatic tachycardia syndrome

Cited by 10 publications

References 25 publications

Effect of Food Intake on Hemodynamic Parameters during the Tilt-Table Test in Patients with Postural Orthostatic Tachycardia Syndrome

Effect of Food Intake on Hemodynamic Parameters during the Tilt-Table Test in Patients with Postural Orthostatic Tachycardia Syndrome

A predictive model of response to metoprolol in children and adolescents with postural tachycardia syndrome

Efficacy of β-Blockers on Postural Tachycardia Syndrome in Children and Adolescents: A Systematic Review and Meta-Analysis

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