Poincaré Plot Is Useful for Distinguishing Vasovagal Syncope From Postural Tachycardia Syndrome in Children

Yuan, Piaoliu; Lian, Zhouhui; Wang, Yuanyuan; Wang, Yaru; Zhang, Chunyu; Du, Junbao; Huang, Yaqian; Liao, Ying

doi:10.3389/fped.2022.758100

Cited by 5 publications

(7 citation statements)

References 44 publications

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“…Na população pediátrica, há alguns estudos sobre essa ferramenta com registros de curta duração para análise espectral durante o TI 7 , 23 - 27 e outros para diferenciação entre SVV e STOP, com gravações pelo sistema Holter de 24 horas. 28 , 29 …”

Section: Discussionunclassified

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: Discussionunclassified

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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“…In the case of cardioinhibitory VVS, the patients after cardioneuroablation treatment had lower mean RR and significantly changed HRV parameters toward parasympathetic withdrawal ( Piotrowski et al, 2022 ). However, other research indicates the usefulness of the heart rate Poincaré plot shape analyses in VVS diagnosis ( Yuan et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

An assessment of heart rate and blood pressure asymmetry in the diagnosis of vasovagal syncope in females

Pawłowski

Zalewski²,

Newton³

et al. 2023

Front. Physiol.

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Introduction: Heart Rate Asymmetry (HRA) describes a phenomenon of differences between accelerations and decelerations in human heart rate. Methods used for HRA assessment can be further implemented in the evaluation of asymmetry in blood pressure variations (Blood Pressure Asymmetry—BPA).Methods: We have analyzed retrospectively the series of heartbeat intervals extracted from ECG and beat-to-beat blood pressure signals from 16 vasovagal patients (age: 32.1 ± 13.3; BMI: 21.6 ± 3.8; all female) and 19 healthy subjects (age: 34.6 ± 7.6; BMI: 22.1 ± 3.4; all female) who have undergone tilt test (70°). Asymmetry was evaluated with Poincaré plot-based methods for 5 min recordings from supine and tilt stages of the test. The analyzed biosignals were heart rate (RR), diastolic (dBP) and systolic Blood Pressure (sBP) and Pulse Pressure (PP). In the paper we explored the differences between healthy and vasovagal women.Results: The changes of HRA indicators between supine and tilt were observed only in the control group (Porta Index p = 0.026 and Guzik Index p = 0.005). No significant differences in beat-to-beat variability (i.e. spread of points across the line of identity in Poincaré plot—SD1) of dBP was noted between supine and tilt in the vasovagal group (p = 0.433 in comparison to p = 0.014 in healthy females). Moreover, in vasovagal patients the PP was significantly different (supine: 41.47; tilt: 39.27 mmHg) comparing to healthy subjects (supine: 35.87; tilt: 33.50 mmHg) in supine (p = 0.019) and in tilt (p = 0.014).Discussion: Analysis of HRA and BPA represents a promising method for the evaluation of cardiovascular response to orthostatic stressors, however currently it is difficult to determine a subject’s underlying health condition based only on these parameters.

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“…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: 98%

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

Yuan,

Lian,

Wang

et al. 2023

Front. Neurosci.

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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.

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Poincaré Plot Is Useful for Distinguishing Vasovagal Syncope From Postural Tachycardia Syndrome in Children

Cited by 5 publications

References 44 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

An assessment of heart rate and blood pressure asymmetry in the diagnosis of vasovagal syncope in females

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

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