Clinical characteristics and hemodynamic responses to head-up tilt test in children and adolescents with unexplained sighing

Zou, Runmei; Wang, Shuo; Li, Fang; Lin, Ping; Zhang, Juan; Wang, Yuwen; Xu, Yang; Wang, Cheng

doi:10.1007/s10072-020-04956-8

Cited by 6 publications

(7 citation statements)

References 19 publications

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“…Regarding the vasovagal response pattern to TT, the majority showed a vasodepressor response (up to 77.4%), followed by a mixed response, 19 , 20 similar to said study. However, other studies with a smaller sample size showed a predominant mixed response, with rates of 74.3% and 49.4%.…”

Section: Discussionsupporting

confidence: 86%

“…No que tange ao padrão de resposta vasovagal ao TI, a maioria apresentou resposta vasodepressora (até 77,4%), seguida da resposta mista, 19 , 20 similar ao estudo em questão. Todavia, há outros estudos com casuística menor que demonstraram resposta mista predominante, com taxas de 74,3% e 49,4%.…”

Section: Discussionunclassified

“… 1 , 5 , 39 In the pediatric population, the pharmacological phase, either with isoproterenol or nitroglycerin, was used in some studies. 6 , 20 , 40 - 42 However, nitroglycerin can produce prolonged vasovagal symptoms with less sensitivity, inducing a vasodepressor response, and it is not usually recommended. 41 - 43 In this study, none of these agents were used, despite the elective peripheral venous access, which was performed followed by rest in the supine position for 20 minutes, as recommended by the guidelines.…”

Section: Discussionmentioning

confidence: 99%

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Perfil Clínico, Autonômico e Escore de Calgary Modificado de Crianças e Adolescentes com Presumida Síncope Vasovagal Submetidos ao Teste de Inclinação

Oliveira¹,

Silva²,

Tonelli³

et al. 2023

Arquivos Brasileiros De Cardiologia

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Resumo Fundamento A síncope, na população pediátrica, tem como sua principal causa, a vasovagal (SVV). Sua avaliação deve ser feita por métodos clínicos e o teste de inclinação (TI) pode contribuir para seu diagnóstico. Objetivos Analisar o perfil clínico, os escores de Calgary e de Calgary modificado, a resposta ao TI e a variabilidade da frequência cardíaca (VFC) de pacientes ≤ 18 anos de idade, com presumida SVV. Comparar as variáveis entre pacientes com resposta positiva e negativa ao TI. Método Estudo observacional e prospectivo, com 73 pacientes com idades entre 6 e 18 anos, submetidos à avaliação clínica e ao cálculo dos escores, sem o conhecimento do TI. Este foi feito a 70º sob monitoramento para análise da VFC. Valor-p < 0,05 foi considerado como o critério de significância estatística. Resultados A mediana de idade foi de 14,0 anos, sendo que 52% eram no sexo feminino, 72 apresentaram Calgary ≥ -2 (média 1,80) e 69 com Calgary modificado ≥ -3 (média 1,38). Ocorreram pródromos em 59 pacientes, recorrência em 50 e trauma em 19. A resposta ao TI foi positiva em 54 (49 vasovagal, com 39 vasodepressora), com aumento do componente de baixa frequência (BF) e diminuição da alta frequência (AF) (p < 0,0001). Na posição supina, o BF foi de 33,6 no sexo feminino e 47,4 em unidades normalizadas no sexo masculino (p = 0,02). Aplicando-se a curva de operação característica para TI positivo, não houve significância estatística para VFC e os escores. Conclusões A maioria das crianças e adolescentes com diagnóstico presumido de SVV apresentaram um cenário clínico típico, com escore de Calgary ≥ -2, e resposta vasodepressora predominante ao TI. Verificou-se uma maior ativação simpática na posição supina no sexo masculino. Os escores de Calgary e a ativação simpática não permitiram predizer a resposta ao TI.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionunclassified

Section: Discussionmentioning

confidence: 99%

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Perfil Clínico, Autonômico e Escore de Calgary Modificado de Crianças e Adolescentes com Presumida Síncope Vasovagal Submetidos ao Teste de Inclinação

Oliveira¹,

Silva²,

Tonelli³

et al. 2023

Arquivos Brasileiros De Cardiologia

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“…The European Syncope Guidelines recommendations combined with HUTT identified 81% of the patients as having non-cardiac syncope, thus potentially avoiding a large number of unnecessary diagnostic tests. Zou et al ( 8 ) found that children with unexplained sighs responded positively to HUTT and that the results indicated that sighing was associated with autonomic nervous system dysfunction. HUTT is an important tool for assessing autonomic nervous system function and can also be used to describe the hemodynamic pattern of unexplained sighing in children and adolescents ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac autonomic function status can be assessed by head-up tilt test (HUTT), postural changes, heart rate variability and other methods. HUTT is an important method to evaluate autonomic nerve function clinically ( 8 , 9 ). At present, HUTT has become the gold standard for diagnosing vasovagal syncope (VVS).…”

Section: Introductionmentioning

confidence: 99%

The Relationship Between Unexplained Chest Pain in Children and Head-Up Tilt Test

Wang

Zou

et al. 2022

Front. Pediatr.

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BackgroundTo explore the relationship between unexplained chest pain in children and head-up tilt test (HUTT).Materials and MethodsA total of 825 children with the main symptom of unexplained chest pain were admitted to the Specialist Outpatient Clinic of Children’s Cardiovascular Disease from October 2000 to November 2021 at The Second Xiangya Hospital, Central South University. Among them, 473 were male and 352 were female, with a mean age of 10.61 ± 2.21 years. The control group included 58 cases, comprising 35 males and 23 females, with a mean age of 10.26 ± 2.66 years. The detailed history, physical examinations, conventional 12-lead electrocardiogram, chest X-ray, echocardiography, myocardial enzymes, electroencephalogram, and blood series were all examined. Disorders of the chest wall, lung, heart, mediastinum, and esophageal reflux, as well as drug effects, were ruled out. All the children underwent HUTT. Demographic description, univariate analysis, and multivariate logistic regression analysis were used to explore the possible linear or non-linear relationships between the children’s unexplained chest pain and HUTT.ResultsAmong the 825 chest pain cases, 301 (36.48%) were HUTT positive and 524 (63.52%) were HUTT negative. HUTT-positive patients were older than HUTT-negative patients (11.04 ± 2.03 vs. 10.34 ± 2.31 years, P < 0.001). The logistic regression results showed that each year of age increased the probability of being HUTT positive by 17.90% (P < 0.000), and females were 91.30% more likely to be HUTT positive than males (P < 0.000).ConclusionClinically unexplained chest pain in children is mainly caused by unbalanced autonomic nervous function. HUTT can help clear the cause of unexplained chest pain.

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Autonomic dysfunction in SARS-COV-2 infection acute and long-term implications COVID-19 editor’s page series

Becker

2021

J Thromb Thrombolysis

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The autonomic nervous system (ANS) is a complex network of nerves originating in the brain, brain stem, spinal cord, heart and extracardiac organs that regulates neural and physiological responses to internal and external environments and conditions. A common observation among patients with the 2019 Coronavirus (CoV) (SARS-severe acute respiratory syndrome CoV-2) (SARS-CoV-2) or COVID-19 [ CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019)] in the acute and chronic phases of the disease is tachycardia, labile blood pressure, muscular fatigue and shortness of breath. Because abnormalities in the ANS can contribute to each of these symptoms, herein a review of autonomic dysfunction in SARS-COV-2 infection is provided to guide diagnostic testing, patient care and research initiatives. Graphic abstract The autonomic nervous system is a complex network of nerves originating in the brain, brain stem, spinal cord, heart and extracardiac organs that regulates neural and physiological responses to internal and external environments and conditions. A common collection of signs and symptoms among patients with the 2019 Coronavirus (CoV) (SARS-severe acute respiratory syndrome CoV-2) (SARS-CoV-2) or COVID-19 [ CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019)] is tachycardia, labile blood pressure, muscular fatigue and shortness of breath. Abnormalities in the autonomic nervous system (ANS) can contribute to each of these identifiers, potentially offering a unifying pathobiology for acute, subacute and the long-term sequelae of SARS-CoV-2 infection (PASC) and a target for intervention.

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Clinical characteristics and hemodynamic responses to head-up tilt test in children and adolescents with unexplained sighing

Cited by 6 publications

References 19 publications

Perfil Clínico, Autonômico e Escore de Calgary Modificado de Crianças e Adolescentes com Presumida Síncope Vasovagal Submetidos ao Teste de Inclinação

Perfil Clínico, Autonômico e Escore de Calgary Modificado de Crianças e Adolescentes com Presumida Síncope Vasovagal Submetidos ao Teste de Inclinação

The Relationship Between Unexplained Chest Pain in Children and Head-Up Tilt Test

Autonomic dysfunction in SARS-COV-2 infection acute and long-term implications COVID-19 editor’s page series

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