Hemodynamic characteristics during the initial phase of head-up tilt test in children with postural orthostatic tachycardia syndrome and the value for predicting vasovagal syncope
10.3760/cma.j.issn.1673-4912.2025.09.004
- VernacularTitle:体位性心动过速综合征儿童直立倾斜试验初期血流动力学特征及其预测血管迷走性晕厥的价值
- Author:
Dan ZHANG
1
;
Yao LIN
1
;
Yanyan LIU
1
;
Yang LIU
1
;
Lin SHI
1
Author Information
1. 首都医科大学附属首都儿童医学中心心血管内科，北京 100020
- Publication Type:Journal Article
- Keywords:
Postural orthostatic tachycardia syndrome;
Vasovagal syncope;
Head-up tilt test;
Blood pressure;
Children
- From:
Chinese Pediatric Emergency Medicine
2025;32(9):656-662
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze hemodynamic characteristics during the initial phase of the head-up tilt test (HUTT) in children with postural orthostatic tachycardia syndrome (POTS) and the value for predicting vasovagal syncope(VVS).Methods:This was a case-control study involving 123 POTS patients who underwent HUTT in the Pediatric Cardiovascular Department at the Children's Hospital,Capital Institute of Pediatrics,from January 2021 to August 2023.According to HUTT results,participants were divided into POTS combined with VVS group( n=82) and POTS group( n=41).The general conditions,clinical symptoms,24-hour urine sodium levels,and hemodynamics changes during the initial phase of HUTT between the two groups were compared. Results:The prevalence of POTS combined with VVS was 66.13% (82/123).There were no significant differences in age,sex,body mass index,24-hour urinary sodium,heart rate,heart rate variability,and maximum heart rate variability during the initial phase of HUTT between the two groups( P>0.05).Compared to the POTS group,the 10-minute systolic blood pressure(SBP10),10-minute diastolic blood pressure (DBP10),and 10-minute mean blood pressure(MBP10) in the POTS combined with VVS group were significantly lower [SBP10: 104(98.8,114.3) vs. 111(105,121.5)mmHg, Z=-3.071, P<0.05; DBP10: 63.44±8.36 vs. 68.29±6.43 mmHg, t=-3.265, P <0.05; MBP10: 78.31±9.74 vs. 83.28±7.30 mmHg, t =-2.879, P<0.05].Receiver operating characteristic curve analysis showed that DBP10,the difference between baseline DBP and DBP at 10-minute (△DBP10),and the in creasing rate of DBP10(△DBPR10) were predictive factors for POTS combined with VVS,with cut-off values of 67.5 mmHg (AUC=0.687,sensitivity 67.5%,specificity 72.0%),7.5 mmHg (AUC=0.633,sensitivity 43.9%,specificity 79.3%),and -2.84% (AUC=0.631,sensitivity 92.7%,specificity 31.7%),respectively.The combined predictive value was more significant (AUC=0.709, P<0.05),with sensitivity and specificity of 70.7% and 67.1%,respectively.In terms of age,DBP10 exhibited a higher predictive value in patients aged 13-18 years,with a DBP10 cut-off of 64.5 mmHg,AUC of 0.762,sensitivity of 92.7%,and specificity of 31.7%. Conclusion:The rate of HUTT-proven VVS in POTS was 66.13%.△DBP10,DBP10 and △DBPR10 have predictive value for POTS combined with VVS.Additionally,DBP10 shows a higher predictive value in patients aged 13-18 years.
