No abstract available.
Diagnosis* ; Syncope, Vasovagal*

BACKGROUND AND OBJECTIVES: The head-up tilt test (HUT) is widely used for the diagnosis of vasovagal syncope. To improve the sensitivity of the test, provocation with isoproterenol is frequently used. The aim of this study was to evaluate the values of isosorbide dinitrate spray as a provocation drug in the HUT. SUBJECTS AND METHODS: Two hundred patients, undergoing baseline HUT (60 degrees for 20 minutes) for suspected vasovagal syncope or presyncope and unexplained dizziness, were enrolled. If the baseline HUT was negative, isosorbide dinitrate (2.5 mg) spray was applied sublingually (group I, n=93), or isoproterenol (3 microgram/min) infused (group II, n=93), in a randomized fashion. The values of isosorbide dinitrate and isoproterenol were compared in those patients that developed a positive vasovagal response or who completed the drug-provocative HUT. RESULTS: Syncope was similarly reproduced in both groups (47.7 vs. 41.9%, p>0.05). Type I responses were most common in both groups, and types I and II responses were more common in group I than group II (78.0 vs. 55.6% and 12.2 vs. 5.6%, p<0.05, respectively). The average time to a positive response was longer in group I than group II (8.5+/-3.4 vs. 6.1+/-3.6 minutes, p<0.01). The sensitivity and specificity of the drug-provocative HUT were significantly higher in group I than group II (73.5 and 87.5% vs. 58.5 and 71.1%; respectively, p<0.01). The incidence of minor adverse effects were similar in both groups, but serious cardiac side effects were significantly more common in group II than group I (4.3 vs. 0%, p<0.05). CONCLUSION: Sublingual isosorbide dinitrate spray may be used as a simple, effective and well tolerated provocative drug during HUT.
Diagnosis ; Dizziness ; Humans ; Incidence ; Isoproterenol* ; Isosorbide Dinitrate ; Sensitivity and Specificity ; Syncope ; Syncope, Vasovagal ; Tilt-Table Test

Objective: To investigate the predictive value of blood cell parameters in children with vasovagal syncope (VVS). Methods: In this case-control study, the VVS group included 111 patients with unexplained syncope or prodromata who were diagnosed with VVS by head-up tilt test in the Second Xiangya Hospital, Central South University from January 2018 to October 2020, and 111 healthy children were enrolled as control. The differences in blood cell parameters between the 2 groups were compared by t test and Mann-Whitney U test. Multivariate binary Logistic regression was used to analyze the independent correlation factors of VVS, and receiver operating characteristic (ROC) curve to explore the predictive value of blood cell parameters for diagnosing VVS. Results: Sex composition ratios were consistent in the 2 groups (51 males vs. 60 females), while the age of the VVS group was higher than that of the control group (11.0 (8.0, 12.5) vs. 8.0 (7.0, 11.0) years, Z=4.39, P<0.001). Compared with the control group, VVS group had lower level of white blood cell (WBC) (6.0 (5.3, 7.1)×10⁹ vs. 8.6 (6.7, 10.1)×10⁹/L, Z=-7.96, P<0.001), lymphocyte (LY) (2.3 (1.9, 2.7)×10⁹ vs. 4.0 (2.8, 6.3)×10⁹/L, Z=-8.49, P<0.001), lymphocyte ratio (0.39 (0.33, 0.44) vs. 0.52 (0.37, 0.69), Z=-5.59, P<0.001), monocyte (0.3 (0.3, 0.4)×10⁹ vs. 0.4 (0.3, 0.6)×10⁹/L, Z=-6.19, P<0.001), eosinophil (0.1 (0.1, 0.2)×10⁹ vs. 0.2 (0.2, 0.4)×10⁹/L, Z=-5.75, P<0.001), mean corpuscular-hemoglobin concentration (MCHC) ((328±12) vs. (333±11) g/L, t=-3.27, P<0.001) and blood platelet (263 (235, 313)×10⁹ vs. 341 (295, 409)×10⁹/L, Z=-2.69, P<0.001), but higher neutrophil ratio (0.53 (0.48, 0.58) vs. 0.37 (0.22, 0.54), Z=5.86, P<0.001), hematocrit (0.39±0.04 vs. 0.37±0.04, t=2.75, P=0.006), mean corpuscular volume (MCV) (85 (82, 88) vs. 81 (78, 84) fl, Z=5.56, P<0.001), mean corpuscular hemoglobin (28 (27, 29) vs. 27 (26, 28) pg, Z=3.39, P=0.001), red cell distribution width (39 (37, 41) vs. 37 (36, 40) fl, Z=4.02, P<0.001) and mean platelet volume (11 (10, 11) vs. 10 (9, 11) fl, Z=2.81, P=0.005) levels. After adjusting for confounding factors such as sex and age, LY (OR=0.42, 95%CI 0.29-0.62, P<0.001), WBC (OR=0.75, 95%CI 0.59-0.95, P=0.015), MCHC (OR=0.94, 95%CI 0.91-0.97, P<0.001) were independent negative correlation factors of VVS, while MCV (OR=1.08, 95%CI 1.01-1.15, P=0.021) was independent positive correlation factor. ROC curve showed that the combination of LY, WBC, MCV and MCHC had acceptable predictive value for the diagnosis of VVS, with area under curve of 0.88, sensitivity of 0.80, specificity of 0.83, and Youden index of 0.63. Conclusions: Compared with healthy children, the blood cell parameters usually change in those with VVS. Combination of LY, WBC, MCHC and MCV can facilitate the diagnosis of VVS in children with unexplained syncope or prodromata.
Case-Control Studies ; Child ; Female ; Humans ; Lymphocytes ; Male ; Syncope ; Syncope, Vasovagal/diagnosis* ; Tilt-Table Test

OBJECTIVETo study the changes in clinical features of vasovagal syncope (VVS) in children.

METHODSFrom January 2000 to September 2009, 841 children with unexplained syncope or prodromata were enrolled. They were assigned to two groups according to the period of visiting hospital: group A (from January 2000 to December 2004, n=129) and group B (from January 2005 to September 2009, n=712). They were assigned to three age groups: 4-6 years old, 7-10 years old and 11-18 years old. A head-up tilt table test (HUTT) was performed on all the subjects.

RESULTSThe total positive rate of HUTT was 45.3% (381/841). Compared with that in group A, the positive rate of HUTT in group B increased significantly (47.5% vs 33.3%; P<0.05). The positive rate of HUTT in female children was significantly higher than that in male children (49.3% vs 37.9%; P<0.05). The positive rate of HUTT increased with age and it was the highest in children at age of 11-18 years (49.2%), followed by in children at age of 7-10 years (44.1%) and 4-6 years (37.1%) (P<0.05). The children at age of 7-10 years and 11-18 years from group B showed significantly higher positive rate of HUTT than those from group A (46.2% vs 27.8%; 54.0% vs 32.6%, P<0.05). Vasodepressor type was the most common response type (70.9%) shown by HUTT compared with mixed type (25.5%) and cardioinhibitory type (3.6%) (P<0.05). The proportion of children with vasodepressor response type in group B was significantly higher than that in group A (72.5% vs 58.1%; P<0.05).

CONCLUSIONSThere were obvious changes in the prevalence of VVS and response types before and after five years, suggesting that the development of VVS may be attributed to many factors, such as social factors, mental factor and life style.

Adolescent ; Child ; Female ; Humans ; Male ; Syncope, Vasovagal ; diagnosis ; Tilt-Table Test

OBJECTIVEThis study aimed at analyzing the usefulness of a modified Calgary Syncope Syndrome Score in the differential diagnosis between cardiac syncope (CS) and vasovagal syncope (VVS) in children through a large sample clinical study.

METHODTotally 189 children [112 males, 77 females, aged 2 - 18 yrs, mean age (12.4 ± 3.1) yrs] with CS and VVS who were at the syncope clinic or admitted to the Department of Pediatrics, Peking University First Hospital from August 2002 to April 2011 were included in the study. The diagnosis was analyzed by a modified Calgary Syncope Syndrome Score and receiver operating characteristic (ROC) curve was used to explore the predictive value of different Calgary Syncope Syndrome Scores in differential diagnosis between CS and VVS.

RESULTThere were significant differences in the score between CS [-5.00(-7, 1)] and VVS [1(-4, 6)] (P < 0.01). When the score was ≤ -2.5, the sensitivity and specificity of the differential diagnosis between CS and VVS were 95.4% and 67.7%, respectively. Since the modified Calgary Syncope Syndrome Score was integer number, CS should be considered when the score was less than -3.

CONCLUSIONThe modified Calgary Syncope Syndrome Score might be used as an initial diagnostic method in differential diagnosis between CS and VVS, based on the history of the patients.

Adolescent ; Child ; Child, Preschool ; Diagnosis, Differential ; Female ; Heart Diseases ; complications ; Humans ; Male ; Sensitivity and Specificity ; Syncope ; diagnosis ; etiology ; Syncope, Vasovagal ; diagnosis ; Tilt-Table Test

PURPOSE: The differential diagnosis between seizure and syncope in a child who visits pediatric neurology clinic with the history of loss of consciousness (LOC), is always challenging issues to the pediatricians. We tried to identify the clinical and laboratory differences between epilepsy and syncope and evaluate the usefulness of EEG and head-up tilt test. METHODS: We retrospectively reviewed the medical records of children who visited pediatric neurology clinic in Asan Medical Center with history of LOC from 2007 to 2011. Patients were divided into three groups, as syncope, epilepsy and syncope with epilepsy, by the diagnosis at the last follow-up. The initial clinical presentations and laboratory findings of each group were evaluated. RESULTS: A total of 145 children were reviewed, but 84 children out of them were included (45 boys, mean age; 13.2 years). Seventy of 84 children (83%) were diagnosed as syncope, 8 (10%) syncope with epilepsy, 6 (7%) epilepsy. Among the syncope groups, neurocardiogenic syncope was the most common, 67(95.7%). The ictal phenomenon such as aura, eyeball deviation, cyanosis and urination were significantly higher in epilepsy patients (P<0.001). The abnormal EEG findings were more likely to be in the epilepsy group, but the sensitivity and specificity was 57%, 90%, respectively. The sensitivity and specificity of head-up tilt tests for syncope were 79% and 100%. Recurrence during follow-up periods were more frequent in epilepsy group (1.2+/-3.8 vs 10+/-10.3, P<0.001). CONCLUSION: Appropriate assessment from history and laboratory data may lead to the proper diagnosis and management in children with LOC, and the careful follow-up and reevaluations are essential to prevent recurrence of LOC.
Child ; Chungcheongnam-do ; Cyanosis ; Diagnosis ; Diagnosis, Differential* ; Electroencephalography ; Epilepsy* ; Follow-Up Studies ; Humans ; Medical Records ; Neurology ; Recurrence ; Retrospective Studies ; Seizures ; Sensitivity and Specificity ; Syncope* ; Syncope, Vasovagal ; Unconsciousness ; Urination

OBJECTIVETo analyze the clinical characteristics in adults and children with vasovagal syncope (VVS).

METHODSClinical data including head-up tilt table (HUTT) results were analyzed and compared in 136 children (mean age 12.3 +/- 2.7 years, 50 boys, 86 girls) and 119 adults (mean age 36.4 +/- 14.0 years, 29 men, 90 women) with VVS.

RESULTS(1) There were more female VVS patients in adults group than that in children group (male and female ratio: children group 1:1.7 and adults group 1:3.1, P = 0.033) in this cohort. (2) The incidence of chest distress in adults group was significantly higher than that in children group [45.4 (54/119) vs. 27.2% (37/136), P = 0.003] while the incidence of headache [10.9% (13/119) vs. 20.6% (28/136), P = 0.036] and abdominal pain in children group was significantly higher than that in adults group [7.6% (9/119) vs. 19.1% (26/136), P = 0.008]. (3) Incidences of muggy environment [22.8% (26/114) vs. 12.5% (17/136), P = 0.032] and urination VVS [9.7% (11/114) vs. 1.5% (2/136), P = 0.004] were significantly higher in adults group than those in children group. (4) The mean time of mixed response vasogal episode in adults group was significantly longer than that in children group in sublingual nitroglycerin head-up tilt table test (SNHUT) stage (5.04 +/- 2.27 min vs. 3.50 +/- 1.24 min, P = 0.036).

CONCLUSIONSThe incidences of chest distress, muggy environment and urination VVS were more often and the mean time of vasogal episode of mixed response in SNHUT stage was longer in adults VVS while the incidence of abdominal pain and headache was higher in children VVS patients compared to adults VVS patients.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Male ; Middle Aged ; Syncope, Vasovagal ; diagnosis ; etiology ; Tilt-Table Test ; Young Adult

OBJECTIVETo study the diagnosis of vasovagal syncope (VVS) in children with postural orthostatic tachycardia syndrome (POTS).

METHODSThe clinical data of 57 children with POTS diagnosed by the head-up tilt test between January 2007 and December 2010 were studied retrospectively. Of the 57 children, there were 29 boys and 28 girls who were aged from 5 to 16 years (12.2±1.9 years).

RESULTSTwenty-four (42%) out of 57 children were diagnosed with VVS by prolonging the duration of the head-up tilt test (for the children with orthostatic tolerance): cardioinhibitory (20 cases), mixed (3 cases) and vasoinhibitory (1 case). The POTS children with VVS were older than those without (13.0±1.4 years vs 11.5±2.1 years; P<0.05). There were no significant differences in gender and clinical symptoms between the POTS children with and without VVS.

CONCLUSIONSSome children with POTS may have coexisting VVS, suggesting that it is important to avoid misdiagnosis of VVS by prolonging the duration of head-up tilt test in POTS children with orthostatic tolerance. There are no obvious differences in gender and clinical symptoms between the POTS children with and without VVS.

Adolescent ; Child ; Child, Preschool ; Diagnostic Errors ; Female ; Humans ; Male ; Postural Orthostatic Tachycardia Syndrome ; complications ; Syncope, Vasovagal ; diagnosis ; Tilt-Table Test

BACKGROUNDSyncope is a common clinical problem with multiple causes. Vasovagal syncope (VVS) is by far the most frequent cause of syncope in children and adolescents. The traditional diagnostic approach to VVS of children and adolescents is based on a series of tests to exclude all other causes, which is complex and time and medical resource consuming. Attempts have been made to develop a new cost-effective diagnostic approach to avoid these problems. This study aimed to compare the economic effectiveness and diagnostic value of the traditional diagnostic approach to VVS of children with a new diagnostic approach.

METHODSOne hundred and eighteen children diagnosed as VVS were divided into two groups according to the different diagnostic approaches. The diagnostic value of the two diagnostic approaches was then analyzed. Meanwhile, the costs of hospitalization, diagnostic testing and hospital stay were determined. Data were evaluated by the cost-minimization analysis.

RESULTSThe diagnostic value of the new diagnostic approach was similar to that of the traditional diagnostic approach (56.57% vs. 53.91%, P = 0.697). However, the cost of hospitalization per patient by the new diagnostic approach was (1507.08 ± 144.63) Yuan (RMB) which was less than that of the traditional diagnostic approach (2603.64 ± 208.19) Yuan. The costs of diagnostic tests per patient by the new diagnostic approach was (1256.04 ± 109.14) Yuan and by the traditional approach (2175.22 ± 153.32) Yuan.

CONCLUSIONCompared to the traditional diagnostic approach to diagnose VVS in children and adolescents, the new diagnostic approach is of a good economic value, and it should be popularized in clinical practice.

Adolescent ; Child ; Child, Preschool ; Cost-Benefit Analysis ; methods ; Diagnostic Tests, Routine ; economics ; Female ; Humans ; Male ; Syncope, Vasovagal ; diagnosis

OBJECTIVETo analyze the impact of attack frequency as well as therapy strategies on outcome of patients with vasovagal syncope (VVS).

METHODSA total of 159 patients (aged from 15 - 59 years old) with VVS were included in this study. Patients were divided into low frequency (< 3) group (n = 95) and high (≥ 3) frequency group (n = 64) according to the attack frequency in the past 5 years at the primary survey. Patients received one of the three therapies: no treatment, physical therapy, and comprehensive treatment. All cases were followed up with telephone or outpatient visit for 24 months.

RESULTSIncidence of syncope was significantly higher in the high frequency group and in the low frequency group [40.6% (26/64) vs. 11.6% (11/95), P < 0.01]. The overall improvement rate was significantly higher in the low frequency group than that of high frequency group (P < 0.01). Improvement rate was significantly higher in the physical therapy subgroup and the comprehensive treatment subgroup than no treatment subgroup for patients with low attack frequency [81.8% (27/33) vs. 47.1% (8/17), P < 0.05; 82.2% (37/45) vs. 47.1% (8/17), P < 0.05], and in comprehensive treatment subgroup than in physical therapy subgroups observed between and [62.2% (28/45) vs. 31.6% (6/19), P < 0.05] for patients with high attack frequency.

CONCLUSIONOutcome is related to previous attack frequency for patients with VVS, physical therapy is effective for reducing the recurrence rate of syncope in VVS patients with low attack frequency while physical therapy combined with pharmacotherapy should be applied for VVS patients with high attack frequency to improve outcome.

Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Physical Therapy Modalities ; Prognosis ; Syncope, Vasovagal ; diagnosis ; therapy ; Treatment Outcome ; Young Adult