Serum Vitamin D Levels in Children and Adolescents with Vasovagal Syncope, Syncope Due to Orthostatic Hypotension, and Cardiac Syncope

Overview

Journal Turk Arch Pediatr

Publisher Aves

Specialty Pediatrics

Date 2023 Jan 4

PMID 36598210

Authors

Tetiana Kovalchuk

Oksana Boyarchuk

Affiliations

Soon will be listed here.

Abstract

Objective: The study aimed to compare vitamin D levels between children and adolescents with vasovagal syncope, syncope due to orthostatic hypotension, cardiac syncope, and healthy individuals and to investigate the correlations of 25(OH)D with main clinical parameters of syncope.

Materials And Methods: This study involved 83 children aged 8-17 years with syncope: 40 with vasovagal syncope, 24 with syncope due to orthostatic hypotension, and 19 with cardiac syncope. There were 24 healthy volunteers in the control group. Data concerning active standing test, electrocardiography, echocardiography, electroencephalography, and 24-hour Holter monitoring findings were collected. Serum vitamin D was evaluated by an enzyme-linked immunoassay technique test.

Results: The mean levels of serum 25(OH)D were decreased in children with vasovagal syncope (18.8 ± 5.9 ng/mL), syncope due to orthostatic hypotension (19.9 ± 6.7 ng/mL), and cardiac syncope (20.6 ± 7.3 ng/mL) in comparing with the control group (30.9 ± 5.9 ng/mL; P < .001). In patients with syncope due to orthostatic hypotension, vitamin D deficiency was associated with a reduction in systolic blood pressure (r = 0.43) and diastolic blood pressure (r = 0.38) within the first minute, lower systolic blood pressure (r = 0.44) within the third minute of active orthostasis (P < .05). There were significant correlations of vitamin D deficiency with parameters of cardiac autonomic activity pNN50 (r = 0.49), total power (r = 0.39), and low frequency index (r = 0.35) in children with cardiac syncope (P < .05), while heart rate variability was not affected in patients with vasovagal syncope and syncope due to orthostatic hypotension (P > .05).

Conclusion: Children and adolescents with vasovagal syncope, syncope due to orthostatic hypotension, as well as cardiac syncope had higher frequency of vitamin D deficiency than healthy pediatric controls. This provides a new approach to syncope management in pediatric population, requiring further studies.

Citing Articles

Comment On: Serum Vitamin D Levels in Children and Adolescents with Vasovagal Syncope, Syncope due to Orthostatic Hypotension, and Cardiac Syncope.

Al-Mendalawi M Turk Arch Pediatr. 2023; 58(4):454-455.

PMID: 37317578 PMC: 10441138. DOI: 10.5152/TurkArchPediatr.2023.23037.

Association between vitamin D deficiency and vasovagal syncope: A systematic review and meta-analysis.

Khalaji A, Behnoush A, Tajdini M Clin Cardiol. 2023; 46(7):721-728.

PMID: 37226313 PMC: 10352974. DOI: 10.1002/clc.24035.

References

Friedman K, Alexander M . Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease. J Pediatr. 2013; 163(3):896-901.e1-3. PMC: 3982288. DOI: 10.1016/j.jpeds.2013.05.001. View

Wadhwania R . Is Vitamin D Deficiency Implicated in Autonomic Dysfunction?. J Pediatr Neurosci. 2017; 12(2):119-123. PMC: 5588633. DOI: 10.4103/jpn.JPN_1_17. View

Zou R, Wang S, Cai H, Li F, Lin P, Wang Y . Vitamin D Deficiency in Children With Vasovagal Syncope Is Associated With Impaired Circadian Rhythm of Blood Pressure. Front Neurosci. 2021; 15:712462. PMC: 8387869. DOI: 10.3389/fnins.2021.712462. View

Li Y, He B, Li H, Zhang Q, Tang C, Du J . Plasma Homocysteine Level in Children With Postural Tachycardia Syndrome. Front Pediatr. 2018; 6:375. PMC: 6287046. DOI: 10.3389/fped.2018.00375. View

Tanaka H, Fujita Y, Takenaka Y, Kajiwara S, Masutani S, Ishizaki Y . Japanese clinical guidelines for juvenile orthostatic dysregulation version 1. Pediatr Int. 2009; 51(1):169-79. DOI: 10.1111/j.1442-200X.2008.02783.x. View

Muscogiuri G, Altieri B, Penna-Martinez M, Badenhoop K . Focus on vitamin D and the adrenal gland. Horm Metab Res. 2015; 47(4):239-46. DOI: 10.1055/s-0034-1396893. View

Zhang Q, Sun Y, Zhang C, Qi J, Du J . Vitamin D Deficiency and Vasovagal Syncope in Children and Adolescents. Front Pediatr. 2021; 9:575923. PMC: 7959715. DOI: 10.3389/fped.2021.575923. View

Hurst D, Hirsh D, Oster M, Ehrlich A, Campbell R, Mahle W . Syncope in the Pediatric Emergency Department - Can We Predict Cardiac Disease Based on History Alone?. J Emerg Med. 2015; 49(1):1-7. DOI: 10.1016/j.jemermed.2014.12.068. View

Kesby J, Turner K, Alexander S, Eyles D, McGrath J, Burne T . Developmental vitamin D deficiency alters multiple neurotransmitter systems in the neonatal rat brain. Int J Dev Neurosci. 2017; 62:1-7. DOI: 10.1016/j.ijdevneu.2017.07.002. View

10.

Pludowski P, Karczmarewicz E, Bayer M, Carter G, Chlebna-Sokol D, Czech-Kowalska J . Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe - recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency. Endokrynol Pol. 2013; 64(4):319-27. DOI: 10.5603/ep.2013.0012. View

11.

McCarroll K, Robinson D, Coughlan A, Healy M, Kenny R, Cunningham C . Vitamin D and orthostatic hypotension. Age Ageing. 2012; 41(6):810-3. DOI: 10.1093/ageing/afs088. View

12.

Groves N, McGrath J, Burne T . Vitamin D as a neurosteroid affecting the developing and adult brain. Annu Rev Nutr. 2014; 34:117-41. DOI: 10.1146/annurev-nutr-071813-105557. View

13.

Pektas A, Koken R, Koca H . Serum vitamin B-12 in children presenting with vasovagal syncope. Asia Pac J Clin Nutr. 2017; 27(1):176-181. DOI: 10.6133/apjcn.022017.17. View

14.

Dogdus M, Burhan S, Bozgun Z, Cinier G, Koyuncu I, Karabay C . Cardiac autonomic dysfunctions are recovered with vitamin D replacement in apparently healthy individuals with vitamin D deficiency. Ann Noninvasive Electrocardiol. 2019; 24(6):e12677. PMC: 6931406. DOI: 10.1111/anec.12677. View

15.

Gilani A, Ramsay S, Welsh P, Papacosta O, Lennon L, Whincup P . Vitamin D deficiency is associated with orthostatic hypotension in older men: a cross-sectional analysis from the British Regional Heart Study. Age Ageing. 2020; 50(1):198-204. PMC: 7793603. DOI: 10.1093/ageing/afaa146. View

16.

Franciosi S, Perry F, Roston T, Armstrong K, Claydon V, Sanatani S . The role of the autonomic nervous system in arrhythmias and sudden cardiac death. Auton Neurosci. 2017; 205:1-11. DOI: 10.1016/j.autneu.2017.03.005. View

17.

Mozos I, Marginean O . Links between Vitamin D Deficiency and Cardiovascular Diseases. Biomed Res Int. 2015; 2015:109275. PMC: 4427096. DOI: 10.1155/2015/109275. View

18.

Kalyani R, Stein B, Valiyil R, Manno R, Maynard J, Crews D . Vitamin D treatment for the prevention of falls in older adults: systematic review and meta-analysis. J Am Geriatr Soc. 2010; 58(7):1299-310. PMC: 3125705. DOI: 10.1111/j.1532-5415.2010.02949.x. View

19.

Muir S, Montero-Odasso M . Effect of vitamin D supplementation on muscle strength, gait and balance in older adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2011; 59(12):2291-300. DOI: 10.1111/j.1532-5415.2011.03733.x. View

20.

Mann M, Hollenberg M, Hanley D, Ahmed S . Vitamin D, the autonomic nervous system, and cardiovascular risk. Physiol Rep. 2015; 3(4). PMC: 4425957. DOI: 10.14814/phy2.12349. View