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

Yuan, Piaoliu; Li, Xueying; Tao, Chunyan; Du, Xiaojuan; Zhang, Chunyu; Du, Junbao; Huang, Yaqian; Liao, Ying

doi:10.2147/ijgm.s352928

Cited by 6 publications

(5 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…L/T was calculated from L and T values. A specially assigned person measured the graphs using a method previously shown to have good stability and repeatability ( Yuan et al, 2022a , b ). The method and results of the stability and repeatability tests can be found in the Supplementary material .…”

Section: Methodsmentioning

confidence: 99%

“…In addition, Poincaré plots can intuitively reflect the comprehensive characteristics of the HR variability ( Copie et al, 1996 ; Toichi et al, 1997 ), their shape can reflect the activity of the sympathetic and vagus nerves, and they are noninvasive, intuitive, and stable indicators of autonomic nervous function ( Copie et al, 1996 ; Toichi et al, 1997 ). Based on this, we have previously reported in pediatric population that Poincaré plots can be used to distinguish vasovagal syncope (VVS) from POTS and predict the efficacy of metoprolol in the treatment of VVS ( Yuan et al, 2022a , b ). The mechanism of metoprolol treatment for POTS mainly involves addressing autonomic nervous function imbalance.…”

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Poincaré plot can help predict the curative effect of metoprolol for pediatric postural orthostatic tachycardia syndrome

Yuan,

Lian,

Wang

et al. 2023

Front. Neurosci.

Self Cite

View full text Add to dashboard Cite

PurposeTo study whether a Poincaré plot can help predict the curative effect of metoprolol for postural orthostatic tachycardia syndrome (POTS) in children.MethodsPediatric patients with POTS who were administered metoprolol were retrospectively included. The collected data included general data (sex, age, height, weight, and body mass index), the manifestations and treatment (baseline orthostatic intolerance symptom score and course of metoprolol treatment), vital signs (supine heart rate [HR], supine blood pressure, and increased HR during the standing test), HR variability indexes (standard deviation of normal-to-normal intervals [SDNN]; standard deviation of the averages of normal-to-normal intervals [SDANN]; mean standard deviation of the NN intervals for each 5-min segment [SDNNI]; root mean square of the successive differences [rMSSD]; percentage of adjacent NN intervals that differ by >50 ms [pNN50]; triangular index; ultra-low [ULF], very low [VLF], low [LF], and high frequency [HF]; total power [TP]; and LF/HF ratio), and graphical parameters of the Poincaré plot (longitudinal axis [L], transverse axis [T], and L/T). Receiver operator characteristic curves were used to calculate the predictive function of the indexes with significant differences between patients who responded and those who did not. The index combination with the highest predictive value was obtained through series–parallel analysis.ResultsOverall, 40 responders and 23 non-responders were included. The L and T in the Poincaré plots and rMSSD, pNN50, HF, and TP of the HR variability data were significantly lower in participants who responded to metoprolol than in participants who did not (p < 0.001). The L/T of participants who responded to metoprolol was greater than that of non-responders (p < 0.001). Moreover, we noted a strong correlation between every two indexes among L, T, rMSSD, pNN50, HF, TP, and L/T (p < 0.05). T < 573.9 ms combined with L/T > 2.9 had the best performance for predicting the effectiveness of metoprolol, with a sensitivity of 85.0%, specificity of 82.6%, and accuracy of 84.1%.ConclusionIn the Poincaré plot, a T < 573.9 ms combined with an L/T > 2.9 helps predict good outcomes of using metoprolol to treat pediatric POTS.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Poincaré plot can help predict the curative effect of metoprolol for pediatric postural orthostatic tachycardia syndrome

Yuan,

Lian,

Wang

et al. 2023

Front. Neurosci.

Self Cite

View full text Add to dashboard Cite

show abstract

“…The SS was calculated based on the symptom frequency, which was used to assess the effectiveness of the metoprolol. The following specific scoring calculation criteria were as follows ( 18 , 20 ): 0 point indicated no symptoms occurred; 1 point, symptoms occurred at most once per month; 2 points, symptoms occurred 2–4 times per month; 3 points, symptoms occurred 2–7 times per week; and 4 points, symptoms occurred at least once per day. The total of individual SS based on the 10 symptoms was used to calculate the final score.…”

Section: Methodsmentioning

confidence: 99%

Baroreflex sensitivity predicts therapeutic effects of metoprolol on pediatric postural orthostatic tachycardia syndrome

Cui

Wang²,

Liu³

et al. 2022

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

ObjectiveTo determine if the baseline baroreflex sensitivity (BRS) could be a useful predictor for the metoprolol therapeutic efficacy on postural orthostatic tachycardia syndrome (POTS) in children.MethodsIn this retrospective case-control study, 54 children suffering from POTS treated with metoprolol were recruited from the pediatric department of Peking University First Hospital. After 2–3 months of metoprolol treatment, all subjects were divided into responders and non-responders based on whether the symptom score (SS) was decreased by over 50% after metoprolol treatment at the follow-up. The baseline demographic parameters and the supine BRS during the head-up tilt test (HUTT) obtained by Finapres Medical System (FMS) were compared between the two groups. The value of BRS to predict the effectiveness of POTS was analyzed by a receiver-operating characteristic (ROC) curve.ResultsThe age, sex, height, weight, body mass index (BMI), course of the disease, baseline SS, medication time, metoprolol dose, and follow-up time of the subjects were not statistically different between the responders and non-responders (P > 0.05). The decline in symptom scores (ΔSS) of the responders was more obvious than that of the non-responders (P < 0.01). The supine BRS, BRS at maximum HR, supine heart rate (HR), and maximum HR were different between responders and non-responders (P < 0.01, P = 0.022, P < 0.01, P = 0.047). The binary multivariable analysis showed that baseline supine BRS was significantly associated with the response to metoprolol therapy [OR: 2.079, 95% CI: (1.077, 4.015), P = 0.029]. According to the ROC curve, the area under the curve (AUC) of baseline BRS was 0.912 (95% CI, 0.840–0.984), with a cut-off value of 8.045 ms/mmHg, yielding a sensitivity and specificity of 75.8% and 95.2%, respectively, in predicting the effectiveness of POTS.ConclusionThe baseline supine BRS level > 8.045 ms/mmHg can predict a good therapeutic response to metoprolol and the results would assist in guiding the individualized β-adrenoceptor blocker use in pediatric patients suffering from POTS.

show abstract

“…Studies have shown that when children with VVS were treated with β-blockers, the L/T in patients of the effective group before treatment was higher than that in the ineffective group. A pre-treatment L/T of 2.7 as a cut-off value yielded a sensitivity and specificity of 88.2% and 82.8%, respectively, to predict the efficacy of β-blockers in children with VVS ( 23 ).…”

Section: Individualized Beta-blocker Therapy For Children With Vvs: B...mentioning

confidence: 99%

Markers for predicting the efficacy of beta-blockers in vasovagal syncope management in children: A mini-review

Wang

Liu²,

Jin³

et al. 2023

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

Vasovagal syncope (VVS) is a common subtype of neurally mediated syncope. It is prevalent in children and adolescents, and critically affects the quality of life of patients. In recent years, the management of pediatric patients with VVS has received extensive attention, and β-blocker serves as an important choice of the drug therapy for children with VVS. However, the empirical use of β-blocker treatment has limited therapeutic efficacy in patients with VVS. Therefore, predicting the efficacy of β-blocker therapy based on biomarkers related to the pathophysiological mechanism is essential, and great progress has been made by applying these biomarkers in formulating individualized treatment plans for children with VVS. This review summarizes recent advances in predicting the effect of β-blockers in the management of VVS in children.

show abstract

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

Cited by 6 publications

References 57 publications

Poincaré plot can help predict the curative effect of metoprolol for pediatric postural orthostatic tachycardia syndrome

Poincaré plot can help predict the curative effect of metoprolol for pediatric postural orthostatic tachycardia syndrome

Baroreflex sensitivity predicts therapeutic effects of metoprolol on pediatric postural orthostatic tachycardia syndrome

Markers for predicting the efficacy of beta-blockers in vasovagal syncope management in children: A mini-review

Contact Info

Product

Resources

About