Predictive Value of Heart Rate and Blood Pressure on the Prognosis of Postural Tachycardia Syndrome in Children

Wang, Shuo; Zou, Runmei; Cai, Hong; Wang, Cheng

doi:10.3389/fped.2022.802469

Cited by 3 publications

(2 citation statements)

References 38 publications

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“…Although these subtypes are not fixed, it has been thought that those with more prominent hyperadrenergic features have a more exaggerated heart rate response to head-up tilt ( 24 ). It has been shown in children that higher heart rate differences at 5 and 10 min of tilt are associated with a poorer prognosis of symptomatic recovery after 3 months of treatment ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Factors associated with initiation of pharmacological therapy and treatment changes in postural orthostatic tachycardia syndrome

Tidd,

Zhang,

Cantrell

et al. 2024

Front. Neurol.

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PurposePostural Orthostatic Tachycardia Syndrome (POTS) is a heterogenous disorder of the autonomic nervous system that is often disabling. There are no FDA-approved therapies for the treatment of this condition. While some patients recover with baseline non-pharmacological intervention, others require repeated trials of off-label pharmacological therapies. The reasoning for this variable treatment response is unknown. The purpose of this work is to identify potential factors that are associated with higher odds of starting pharmacotherapy and/or a higher rate of POTS treatment changes.MethodsChart review of demographic, disease and treatment descriptions, medical history, and tilt table examinations of 322 POTS patients who were diagnosed between 2018 and 2020 at our tertiary care center was completed. We first identified the most significant factors associated with an increased odds of starting pharmacotherapy using variable selection techniques and logistic regression. We then identified the most significant factors associated with changes in POTS treatment strategies using variable selection techniques and negative binomial regression modeling. A significance level of 0.05 was utilized.ResultsA total of 752 POTS-specific treatment courses were cataloged, and 429 treatment changes were observed. The most cited reason for a change in management was uncontrolled symptoms. History of migraine headaches, reported fatigue, reported palpitations and a previous POTS diagnosis at an outside institution were found to be associated with a higher odds of starting pharmacotherapy for POTS symptoms (Odds Ratio of 2.40, 1.94, 2.62, 2.08, respectively). History of migraine headaches, reported fatigue, and higher heart rate differences on tilt table examination were found to be associated with an increase in the rate of POTS treatment changes (44, 66, 13% increase in incidence rate, respectively), while reported neck pain was associated with a decrease (27% decrease in incidence rate).ConclusionOur work identifies important areas of focus in the development of high-quality trials involving both the non-pharmacological and pharmacological treatment of POTS and highlights several characteristics of patients that may be more refractory to both baseline non-pharmacological treatments and current pharmacological treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Factors associated with initiation of pharmacological therapy and treatment changes in postural orthostatic tachycardia syndrome

Tidd,

Zhang,

Cantrell

et al. 2024

Front. Neurol.

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show abstract

“…Although these subtypes are not fixed, it has been thought that those with more prominent hyperadrenergic features have a more exaggerated heart rate response to head-up tilt (24). It has been shown in children that higher heart rate differences at 5 and 10 min of tilt are associated with a poorer prognosis of symptomatic recovery after 3 months of treatment (32).…”

Section: Associated Factor: Heartrate Increase On Tilt Table Examinationmentioning

confidence: 99%

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Guidelines for the diagnosis and treatment of neurally mediated syncope in children and adolescents (revised 2024)

Wang,

Liao,

Wang

et al. 2024

World J Pediatr

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Background Significant progress has been made in the diagnosis and treatment of pediatric syncope since the publication of the “2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents” (“2018 Edition Guidelines”). Therefore, we have revised and updated it to assist pediatricians in effectively managing children with syncope. Data sources According to the “2018 Edition Guidelines”, the expert groups collected clinical evidence, evaluated preliminary recommendations, and then organized open-ended discussions to form the recommendations. This guideline was developed by reviewing the literature and studies in databases including PubMed, Cochrane, EMBASE, China Biomedical Database, and Chinese Journal Full-text Database up to April 2024. Search terms included “syncope”, “children”, “adolescents”, “diagnosis”, and “treatment.” Results The guidelines were based on the latest global research progress and were evidence-based. The classification of syncope etiology, diagnostic procedures, postural tests, such as the active standing test, head-up tilt test, and active sitting test, clinical diagnosis, and individualized treatment for neurally mediated syncope in pediatric population were included. Conclusions The guidelines were updated based on the latest literature. The concepts of sitting tachycardia syndrome and sitting hypertension were introduced and the comorbidities of neurally mediated syncope were emphasized. Some biomarkers used for individualized treatment were underlined. Specific suggestions were put forward for non-pharmacological therapies as well as the follow-up process. The new guidelines will provide comprehensive guidance and reference for the diagnosis and treatment of neurally mediated syncope in children and adolescents.

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Predictive Value of Heart Rate and Blood Pressure on the Prognosis of Postural Tachycardia Syndrome in Children

Cited by 3 publications

References 38 publications

Factors associated with initiation of pharmacological therapy and treatment changes in postural orthostatic tachycardia syndrome

Factors associated with initiation of pharmacological therapy and treatment changes in postural orthostatic tachycardia syndrome

Table_1.docx

Guidelines for the diagnosis and treatment of neurally mediated syncope in children and adolescents (revised 2024)

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