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

Overview

Journal Int J Gen Med

Publisher Dove Medical Press

Specialty General Medicine

Date 2022 Mar 18

PMID 35300141

Authors

Piaoliu Yuan

Xueying Li

Chunyan Tao

Xiaojuan Du

Chunyu Zhang

Junbao Du

Yaqian Huang

Ying Liao

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

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References

Goldstein D, Holmes C, Frank S, Naqibuddin M, Dendi R, Snader S . Sympathoadrenal imbalance before neurocardiogenic syncope. Am J Cardiol. 2002; 91(1):53-8. DOI: 10.1016/s0002-9149(02)02997-1. View

Liao Y, Li X, Zhang Y, Du J . [Meta-analysis of beta-adrenoceptor blockers for the treatment of vasovagal syncope]. Beijing Da Xue Xue Bao Yi Xue Ban. 2008; 40(6):603-9. View

Kouakam C, Vaksmann G, Pachy E, Lacroix D, Rey C, Kacet S . Long-term follow-up of children and adolescents with syncope; predictor of syncope recurrence. Eur Heart J. 2001; 22(17):1618-25. DOI: 10.1053/euhj.2000.2577. View

Shim S, Park S, Moon S, Oh J, Lee J, Kim H . Baseline heart rate variability in children and adolescents with vasovagal syncope. Korean J Pediatr. 2014; 57(4):193-8. PMC: 4030121. DOI: 10.3345/kjp.2014.57.4.193. View

Moya A, Sutton R, Ammirati F, Blanc J, Brignole M, Dahm J . Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J. 2009; 30(21):2631-71. PMC: 3295536. DOI: 10.1093/eurheartj/ehp298. View

Kanjwal K, Calkins H . Syncope in Children and Adolescents. Cardiol Clin. 2015; 33(3):397-409. DOI: 10.1016/j.ccl.2015.04.008. View

Chaidas K, Tsaoussoglou M, Theodorou E, Lianou L, Chrousos G, Kaditis A . Poincaré plot width, morning urine norepinephrine levels, and autonomic imbalance in children with obstructive sleep apnea. Pediatr Neurol. 2014; 51(2):246-51. DOI: 10.1016/j.pediatrneurol.2014.05.003. View

Mahanonda N, Bhuripanyo K, Kangkagate C, Wansanit K, Kulchot B, Nademanee K . Randomized double-blind, placebo-controlled trial of oral atenolol in patients with unexplained syncope and positive upright tilt table test results. Am Heart J. 1995; 130(6):1250-3. DOI: 10.1016/0002-8703(95)90150-7. View

Tao C, Li X, Tang C, Jin H, Du J . Baroreflex Sensitivity Predicts Response to Metoprolol in Children With Vasovagal Syncope: A Pilot Study. Front Neurosci. 2020; 13:1329. PMC: 6923178. DOI: 10.3389/fnins.2019.01329. View

10.

Wang Y, Wang Y, Li X, Du J, Zhang H, Jin H . Efficacy of Increased Salt and Water Intake on Pediatric Vasovagal Syncope: A Meta-Analysis Based on Global Published Data. Front Pediatr. 2021; 9:663016. PMC: 8155624. DOI: 10.3389/fped.2021.663016. View

11.

Tao C, Tang C, Chen S, Jin H, Du J . Autonomic Nervous Function in Vasovagal Syncope of Children and Adolescents. Neurosci Bull. 2019; 35(5):937-940. PMC: 6754486. DOI: 10.1007/s12264-019-00383-8. View

12.

Woo M, STEVENSON W, Moser D, Trelease R, Harper R . Patterns of beat-to-beat heart rate variability in advanced heart failure. Am Heart J. 1992; 123(3):704-10. DOI: 10.1016/0002-8703(92)90510-3. View

13.

Grubb B . Clinical practice. Neurocardiogenic syncope. N Engl J Med. 2005; 352(10):1004-10. DOI: 10.1056/NEJMcp042601. View

14.

Li H, Gao L, Yuan Y . Advance in the understanding of vasovagal syncope in children and adolescents. World J Pediatr. 2020; 17(1):58-62. DOI: 10.1007/s12519-020-00367-z. View

15.

Kamen P, Krum H, Tonkin A . Poincaré plot of heart rate variability allows quantitative display of parasympathetic nervous activity in humans. Clin Sci (Lond). 1996; 91(2):201-8. DOI: 10.1042/cs0910201. View

16.

Benditt D, Ermis C, Padanilam B, Samniah N, Sakaguchi S . Catecholamine response during haemodynamically stable upright posture in individuals with and without tilt-table induced vasovagal syncope. Europace. 2002; 5(1):65-70. DOI: 10.1053/eupc.2002.0271. View

17.

Tanriverdi Yilmaz S, Binnetoglu K, Babaoglu K, Altun G . Predictors of vasovagal syncope recurrence in children and adolescents and value of head-up tilt table test. Anadolu Kardiyol Derg. 2013; 13(7):688-94. DOI: 10.5152/akd.2013.194. View

18.

Zhang Q, Du J, Zhen J, Li W, Wang Y . [Hemodynamic changes during head-up tilt test and predictive value thereof in predicting the efficacy of metoprolol therapy in children with vasovagal syncope]. Zhonghua Yi Xue Za Zhi. 2007; 87(18):1260-2. View

19.

Marquez M, Gomez-Flores J, Gonzalez-Hermosillo J, Ruiz-Siller T, Cardenas M . [Role of the sympathetic nervous system in vasovagal syncope and rationale for beta-blockers and norepinephrine transporter inhibitors]. Medwave. 2017; 16(Suppl4):e6824. DOI: 10.5867/medwave.2016.6824. View

20.

Kanjwal K, Marine J . Sympathoadrenal imbalance and beta-blockers revisited. Heart Rhythm. 2012; 9(11):1853-4. DOI: 10.1016/j.hrthm.2012.08.028. View