Twenty-four-hour urine NE level as a predictor of the therapeutic response to metoprolol in children with recurrent vasovagal syncope

Kong, Qingyu; Yang, Xiaofei; Cai, Zhifeng; Pan, Yanyan; Wang, Minmin; Liu, Mengmeng; Zhao, Cuifen

doi:10.1007/s11845-019-01979-9

Cited by 15 publications

(14 citation statements)

References 31 publications

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“…However, the method used in the study by Gielerak et al is complex in clinical practice. In 2019, Kong et al attempted to predict therapeutic response to metoprolol in VVS children with 24-h urine norepinephrine and found that patients with 24-h urine norepinephrine > 34.84 µg/24 h seemed to have a better prognosis (Kong et al, 2019). However, this approach was not time-effective.…”

Section: Discussionmentioning

confidence: 99%

Baroreflex Sensitivity Predicts Response to Metoprolol in Children With Vasovagal Syncope: A Pilot Study

Tao

Tang

et al. 2019

Front. Neurosci.

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Objective: To explore the role of baroreflex sensitivity (BRS) in the head-up tilt test (HUTT) in predicting the therapeutic response of vasovagal syncope (VVS) patients to metoprolol. Materials and Methods: Vasovagal syncope patients treated with metoprolol were enrolled in this study and were classified as responders or non-responders according to changes in their symptom scores before and after metoprolol treatment. Values of BRS in the supine position and at positive response occurrence in the HUTT were obtained, and BRS changes from supine to positive response occurrence were calculated. Differences between responders and non-responders were analyzed. Receiver operating characteristic curve analysis was performed to assess the value of BRS for predicting the therapeutic efficacy of metoprolol in pediatric patients with VVS. Results: Forty patients (14 boys; 11.8 ± 2.5 years) diagnosed with VVS were recruited in the study, 28 of whom were verified to be responders to metoprolol and 12 of whom were verified as non-responders. They did not show any differences in baseline characteristics and hemodynamics in the HUTT (p > 0.05). However, the responders had an obviously increased supine BRS value compared to the non-responders (16.9 ± 7.7 ms/mmHg vs. 7.6 ± 3.8 ms/mmHg; p < 0.01). No difference in BRS at positive response occurrence was observed between the two groups (8.9 ± 8.5 ms/mmHg vs. 10.6 ± 9.8 ms/mmHg; p > 0.05). Accordingly, the changes in the BRS of responders were more obvious than in non-responders (8.0 ± 7.8 ms/mmHg vs. −3.0 ± 10.4 ms/mmHg; p < 0.01). The area under the receiver operating characteristic curve for the predictive value of supine BRS was 0.887 (95% CI, 0.779-0.995; p < 0.01). A cutoff value of 10 ms/mmHg yielded a sensitivity and specificity of 82 and 83%, respectively, in predicting the therapeutic efficacy of metoprolol in pediatric VVS patients.

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Section: Discussionmentioning

confidence: 99%

Baroreflex Sensitivity Predicts Response to Metoprolol in Children With Vasovagal Syncope: A Pilot Study

Tao

Tang

et al. 2019

Front. Neurosci.

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“…Due to the obtained results, the use of metoprolol was evaluated in the 38 patients with the condition, and it was concluded that patients who show an effective response to metoprolol are linked to 24-h urine NE high levels in comparison with those without treatment response (40.75 ± 12.86 vs. 21.48 ± 6.49, respectively). Similarly, it was established that patients with 24-h urine NE elevated values have a higher supine blood pressure elevation, both systolic and diastolic and that 24-h urine NE values > 34.84 µg/24 h are indicators that metoprolol treatment can be effective in pediatric patients, with 100% specificity and 70% sensitivity 47 . This opens a door for further studies based on the principles presented in this study.…”

Section: Pharmacological Measuresmentioning

confidence: 98%

Pediatric patients’ head-up-tilt-test with pharmacological challenge, it is safe?

García

Bustillos-García

Rivera-Roodríguez

2020

ACME

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Syncope in pediatrics represents an important cause of visits to the emergency units. For this reason, excluding a cardiac or malignant origin is essential at the time of the initial approach to determine what is the next step in management, or if they need to be referred to a pediatric cardiologist and/or electrophysiologist. Vasovagal syncope is the most frequent cause of syncope in pediatrics, in which a detailed clinical history is enough to make the diagnosis. If no diagnosis is concluded by the history, or if it is necessary to define the hemodynamic response of the patients, the head-up-tilt-test is indicated; this will trigger syncope due to an orthostatic stress caused by the angulated table (passive phase). If a negative response remains, it can be followed by a pharmacologic challenge to trigger the hemodynamic response, which is still controversial in pediatrics. The pharmacologic challenge increases the sensitivity with a slight reduction in test specificity. Although there is not a specific drug for the challenge in pediatric patients yet, the most commonly drugs used are nitrates and isoproterenol, the latter related to a great number of adverse effects. Sublingual administration of nitrates in the challenge has been proven to be ideal, effective, and safe in this specific age group. The aim of this article is to make a literature search to demonstrate the effectiveness and safety of the pharmacologic challenge during the head-up-tilt-test in pediatrics, emphasizing a study conducted at the National Institute of Cardiology with isosorbide dinitrate.

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“…The AUC was 0.9. Using a cutoff value of 34.8 g/24 h yielded a high specificity of 100% but a sensitivity of only 70% [9]. Zhang et al focused on the changes of hemodynamic index during the head-up tilt test (HUTT) and found that the patients whose heart rate increased much greater before the positive response showed better therapeutic response to metoprolol.…”

Section: β-Adrenergic Receptor Blockersmentioning

confidence: 99%

Can pediatric vasovagal syncope be individually managed?

Jin

2022

World J Pediatr

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Twenty-four-hour urine NE level as a predictor of the therapeutic response to metoprolol in children with recurrent vasovagal syncope

Cited by 15 publications

References 31 publications

Baroreflex Sensitivity Predicts Response to Metoprolol in Children With Vasovagal Syncope: A Pilot Study

Baroreflex Sensitivity Predicts Response to Metoprolol in Children With Vasovagal Syncope: A Pilot Study

Pediatric patients’ head-up-tilt-test with pharmacological challenge, it is safe?

Can pediatric vasovagal syncope be individually managed?

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