Usefulness of Plasma Copeptin as a Biomarker to Predict the Therapeutic Effectiveness of Metoprolol for Postural Tachycardia Syndrome in Children

Zhao, Juan; Du, Shuxu; Yang, Jinyan; Lin, Jing; Tang, Chaoshu; Du, Junbao; Jin, Hang

doi:10.1016/j.amjcard.2014.05.039

Cited by 37 publications

(36 citation statements)

References 25 publications

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“…Moreover, copeptin levels were shown to be positively correlated to severity of lower respiratory tract infection, and high levels of copeptin predicted poor long‐term prognosis in patients with chronic heart failure . We have extended previous evidence showing the association between copeptin and clinical problems in pediatric samples to CM exposure – a well‐known risk factor for a variety of diseases later in life.…”

Section: Discussionmentioning

confidence: 88%

Serum copeptin in children exposed to maltreatment

Coelho

Levandowski

Mansur

et al. 2016

Psychiatry Clin Neurosci

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Section: Discussionmentioning

confidence: 88%

Serum copeptin in children exposed to maltreatment

Coelho

Levandowski

Mansur

et al. 2016

Psychiatry Clin Neurosci

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“…A trend for higher AVP in the supine position was also observed in the OH group. The higher AVP may be a reflection of a chronically lower BP, as has been suggested when copeptin was used as an indirect measure of chronically elevated AVP (59). The increase in AVP may be due to lower pressures in the OH group compared with the syncope group at the time of the hormonal measurement, given that syncope occurred later in the HUT.…”

Section: Discussionmentioning

confidence: 94%

“…Future studies may include measuring copeptin levels to further elucidate this question. Copeptin, a stable component of AVP, is a marker of treatment effectiveness for OI, with lower levels of copeptin observed in patients effectively treated with vasoconstrictors (59). Whether OI, Aldo, or AVP/copeptin may also serve as biomarkers for the development of hypertension in this patient population warrants further attention, particularly in light of the absence of long-term cardiovascular longitudinal studies in these patients.…”

Section: Discussionmentioning

confidence: 99%

Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options

Wagoner

Shaltout

Fortunato

et al. 2016

American Journal of Physiology-Heart and Circulatory Physiology

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Studies of adults with orthostatic intolerance (OI) have revealed altered neurohumoral responses to orthostasis, which provide mechanistic insights into the dysregulation of blood pressure control. Similar studies in children with OI providing a thorough neurohumoral profile are lacking. The objective of the present study was to determine the cardiovascular and neurohumoral profile in adolescent subjects presenting with OI. Subjects at 10-18 yr of age were prospectively recruited if they exhibited two or more traditional OI symptoms and were referred for head-up tilt (HUT) testing. Circulating catecholamines, vasopressin, aldosterone, renin, and angiotensins were measured in the supine position and after 15 min of 70° tilt. Heart rate and blood pressure were continuously measured. Of the 48 patients, 30 patients had an abnormal tilt. Subjects with an abnormal tilt had lower systolic, diastolic, and mean arterial blood pressures during tilt, significantly higher levels of vasopressin during HUT, and relatively higher catecholamines and ANG II during HUT than subjects with a normal tilt. Distinct neurohumoral profiles were observed when OI subjects were placed into the following groups defined by the hemodynamic response: postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension (OH), syncope, and POTS/syncope. Key characteristics included higher HUT-induced norepinephrine in POTS subjects, higher vasopressin in OH and syncope subjects, and higher supine and HUT aldosterone in OH subjects. In conclusion, children with OI and an abnormal response to tilt exhibit distinct neurohumoral profiles associated with the type of the hemodynamic response during orthostatic challenge. Elevated arginine vasopressin levels in syncope and OH groups are likely an exaggerated response to decreased blood flow not compensated by higher norepinephrine levels, as observed in POTS subjects. These different compensatory mechanisms support the role of measuring neurohumoral profiles toward the goal of selecting more focused and mechanistic-based treatment options for pediatric patients with OI.

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“…The finding of a greater increase in AVP during orthostasis in patients with POTS may have physiological basis in that a low blood volume is a well-known strong stimulus for AVP release. Of possible clinical relevance relating to these findings, copeptin levels have been suggested to predict the outcome of treatment with midodrine hydrochloride27 and β-blockers in children with POTS 28…”

Section: Discussionmentioning

confidence: 99%

Syndromes of orthostatic intolerance and syncope in young adults

et al. 2017

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ObjectiveTo explore the clinical and neuroendocrine characteristics of syndromes of orthostatic intolerance and syncope in young adults.MethodsTwo hundred and thirty-six patients aged 18–40 years with orthostatic intolerance and/or syncope were examined by head-up tilt test (HUT). Plasma levels of epinephrine, norepinephrine, renin, C-terminal-pro-arginine-vasopressin (CT-proAVP), C-terminal-endothelin-1 and mid-regional-fragment of pro-atrial-natriuretic-peptide (MR-proANP) were analysed. Patients’ history, haemodynamic parameters and plasma biomarkers were related to main diagnoses such as vasovagal syncope (VVS), postural tachycardia syndrome (POTS), orthostatic hypotension (OH) and negative HUT.ResultsNo self-reported symptom of orthostatic intolerance was highly specific for any diagnosis. Patients with VVS (n=103) were more likely to be men (p=0.011) and had lower resting heart rate (HR; 66±11) compared with POTS (73±11; n=72; p=0.001) and negative HUT (74±11; n=39; p=0.001). Patients with POTS demonstrated greater rise in norepinephrine (p=0.008) and CT-proAVP (p=0.033) on standing compared with negative HUT, and lower resting MR-proANP compared with VVS (p=0.04) and OH (p=0.03). Patients with OH had lower resting renin (p=0.03). Subjects with a resting HR <70 and MR-proANP >45 pm/L had an OR of 3.99 (95 % CI 1.68 to 9.52; p=0.002) for VVS compared with subjects without any of these criteria; if male sex was added the OR was 21.8 (95% CI 3.99 to 119; p<0.001).ConclusionsSyndromes of orthostatic intolerance and syncope share many characteristics in younger persons. However, patients with VVS are more likely to be men, have lower HR and higher MR-proANP at rest compared with POTS, which might be taken into account at an early stage of evaluation.

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Usefulness of Plasma Copeptin as a Biomarker to Predict the Therapeutic Effectiveness of Metoprolol for Postural Tachycardia Syndrome in Children

Cited by 37 publications

References 25 publications

Serum copeptin in children exposed to maltreatment

Serum copeptin in children exposed to maltreatment

Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options

Syndromes of orthostatic intolerance and syncope in young adults

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