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Huang Z, Xu Y, Wang S, Liu P, Zen X, Wang Y, Li F, Zou R, Wang C. Differential diagnostic value of P wave dispersion and QT interval dispersion between psychogenic pseudosyncope and vasovagal syncope in children and adolescents. Ital J Pediatr 2025; 51:14. [PMID: 39849646 PMCID: PMC11755812 DOI: 10.1186/s13052-025-01864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 01/12/2025] [Indexed: 01/25/2025] Open
Abstract
BACKGROUND Both psychogenic pseudosyncope (PPS) and vasovagal syncope (VVS) in children and adolescents are diseases of transient loss of consciousness. It is difficult to distinguish them clinically. This paper will study the differential diagnostic value of P wave dispersion (Pd) and QT interval dispersion (QTd) between PPS and VVS. METHODS The 31 children with PPS and 40 children with VVS from July 2014 to November 2023 were enrolled as the study group. Meanwhile, 30 healthy children who underwent a physical examination at the same hospital were matched to the control group. P wave duration and QT interval in the 12-lead electrocardiogram were measured at the baseline. RESULTS (1) Comparison between groups: ① The Pd, corrected P wave dispersion (Pcd), QTd, and corrected QT interval dispersion (QTcd) in PPS group were significantly higher than those in control group (P < 0.05). The minimum P wave duration (Pmin) and corrected P wave duration (Pcmin) in PPS group were significantly lower than those in control group (P < 0.05). There were no significant differences in maximum P wave duration (Pmax), corrected maximum P-wave duration (Pcmax), maximum QT interval (QTmax), minimum QT interval (QTmin), corrected maximum QT interval (QTcmax), and corrected minimum QT interval (QTcmin) between PPS group and control group (P > 0.05). ② The Pd, Pcd, QTd, and QTcd in VVS group were significantly higher than those in control group (P < 0.05). The Pmin, Pcmin, and QTcmin in VVS group were significantly lower than those in control group (P < 0.05). There were no significant differences in Pmax, Pcmax, QTmax, QTmin, and QTcmax between VVS group and control group (P > 0.05). ③ The Pmax, Pd, QTmax, QTd, and QTcd in PPS group were significantly lower than those in VVS group (P < 0.05). There were no significant differences in Pmin, Pcmax, Pcmin, Pcd, QTmin, QTcmax, and QTcmin between PPS group and VVS group (P > 0.05). (2) ROC curve: Pmax, Pd, QTmax, QTd, and QTcd had a certain differential diagnostic value between PPS and VVS in children and adolescents (P < 0.05). QTd had the largest area under curve (0.735), with a sensitivity of 85.00% and a specificity of 53.30% at the cut off value of ≥ 28.11 ms for VVS diagnosis. CONCLUSIONS In children and adolescents, electrocardiogram parameters such as Pmax, Pd, QTmax, QTd, and QTcd all possess predictive value in differentiating between PPS and VVS. Among them, QTd has the greatest differential diagnostic value.
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Affiliation(s)
- Zifeng Huang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Yi Xu
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Shuo Wang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Ping Liu
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Xingfang Zen
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Yuwen Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Fang Li
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Runmei Zou
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Cheng Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China.
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Zhao T, Wang S, Wang M, Cai H, Wang Y, Xu Y, Zou R, Wang C. Research progress on the predictive value of electrocardiographic indicators in the diagnosis and prognosis of children with vasovagal syncope. Front Cardiovasc Med 2022; 9:916770. [PMID: 35935631 PMCID: PMC9353577 DOI: 10.3389/fcvm.2022.916770] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Neurally mediated syncope (NMS) is a common type of syncope in children in clinical practice, among which vasovagal syncope (VVS) is the most frequent. In recent years, more and more studies have been carried out to assess the diagnosis and prognosis of VVS. The electrocardiographic indicators such as heart rate variability (HRV), QT dispersion (QTd), P-wave dispersion (Pd), ventricular late potentials (VLP), deceleration ability of heart rate (DC), etc., are easy to obtain and inexpensive. With the help of electrocardiographic indicators, the diagnostic procedure and individualized treatment strategies of pediatric VVS can be optimized. This article reviews the value of electrocardiographic indicators in the diagnosis and prognosis of children with VVS.
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Affiliation(s)
- Ting Zhao
- Department of Pediatric Cardiovasology, Children’s Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Wang
- Department of Neonatology, Xiangya Hospital, Central South University, Changsha, China
| | - Miao Wang
- Department of Pediatric Cardiovasology, Children’s Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hong Cai
- Department of Pediatric Cardiovasology, Children’s Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuwen Wang
- Department of Pediatric Cardiovasology, Children’s Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Xu
- Department of Pediatric Cardiovasology, Children’s Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Runmei Zou
- Department of Pediatric Cardiovasology, Children’s Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Cheng Wang
- Department of Pediatric Cardiovasology, Children’s Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
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Tao C, Xu B, Liao Y, Li X, Jin H, Du J. Predictor of Syncopal Recurrence in Children With Vasovagal Syncope Treated With Metoprolol. Front Pediatr 2022; 10:870939. [PMID: 35463909 PMCID: PMC9024146 DOI: 10.3389/fped.2022.870939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the predictors for syncopal recurrence in a pediatric population with vasovagal syncope (VVS) treated with metoprolol. Study Design This study was conducted retrospectively among children suffering from VVS with or without syncopal recurrence. Data on the detailed medical history and auxiliary examinations were obtained from the electronic medical records. The risk factors for syncopal recurrence were studied by cox regression analyses and the corresponding best cutoff values were determined using receiver operating characteristic analysis. Kaplan-Meier curves were plotted to determine the trends of the syncopal recurrence-free survival rate. Results Forty-two consecutive VVS children were enrolled in the study. At the end of a median follow-up duration of 9.0 (4.8, 19.1) months, 12 patients (29%) experienced ≥1 syncopal episode. Cox regression analyses revealed that the number of previous syncopal episodes before treatment was a risk factor for syncopal recurrence (hazard ratio = 1.027, 95% confidence interval 1.009 - 1.045, P = 0.003). Moreover, 4 previous syncopal episodes were certified as the best cutoff value, and the Kaplan-Meier curves showed that the syncopal recurrence-free survival rate over time in patients with > 4 previous syncopal episodes was significantly lower than that in patients with ≤4 episodes (P = 0.019 at the log-rank test). Conclusion In a pediatric population with VVS while on the treatment of metoprolol, the number of previous syncopal episodes before treatment played a significant role in predicting syncopal recurrence.
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Affiliation(s)
- Chunyan Tao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Bowen Xu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ying Liao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xueying Li
- Department of Statistics, Peking University First Hospital, Beijing, China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences, Ministry of China, Beijing, China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences, Ministry of China, Beijing, China
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Konno S, Yanagisawa R, Motoki N, Shimodaira S. Predictive factors of poor blood collecting flow during leukocyte apheresis for cellular therapy. Ther Apher Dial 2021; 25:1001-1011. [PMID: 33522707 DOI: 10.1111/1744-9987.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/21/2020] [Accepted: 01/21/2021] [Indexed: 11/27/2022]
Abstract
Leukocyte apheresis is necessary in various cellular therapies. However, maintenance of a stable flow rate during leukocyte apheresis is often difficult, even in patients or donors without major problems. Despite this, predictive methods and evidence regarding the reality of the situation are limited. We conducted a retrospective analysis involving adult patients who required leukocyte apheresis for the treatment of neoplasms using WT1-pulsed dendritic cell vaccine. Monocytes were separated from apheresis products to obtain dendritic cells. All the patients were pre-evaluated based on laboratory and chest X-ray findings and subjected to an identical apheresis procedure. The occurrence of poor blood collecting flow during leukocyte apheresis was monitored, and the frequency, clinical information, and associated risk factors were analyzed. Among 160 cases, poor blood collecting flow was observed in 53 cases (33.1%) in a median time of 54 min (range, 2-127 min) post-initiation of leukocyte apheresis. Owing to difficulty in obtaining higher collecting flow, a longer procedure time was required, and in some cases, the scheduled apheresis cycles could not be completed. Consequently, the number of harvested monocytes was low. Multivariable analysis indicated that female patients have an increased risk of poor inlet flow rate. Furthermore, prolonged QT dispersion (QTD) calculated using Bazett's formula was found to be a risk factor. Although the patients did not present any major problems during leukocyte apheresis, poor blood collecting flow was observed in some cases. Sex and pre-evaluated QTD might be useful predictors for these cases; however, further prospective evaluation is necessary.
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Affiliation(s)
- Saori Konno
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan.,Division of Blood Transfusion, Shinshu University Hospital, Matsumoto, Japan
| | - Ryu Yanagisawa
- Division of Blood Transfusion, Shinshu University Hospital, Matsumoto, Japan.,Center for Advanced Cell Therapy, Shinshu University Hospital, Matsumoto, Japan
| | - Noriko Motoki
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shigetaka Shimodaira
- Department of Regenerative Medicine, Kanazawa Medical University, Uchinada, Japan
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Tao CY, Li HX, Li XY, Tang CS, Jin HF, DU JB. [Hemodynamic changes in standing-up test of children and adolescents with postural tachycardia syndrome]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:414-421. [PMID: 31209411 DOI: 10.19723/j.issn.1671-167x.2019.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore the hemodynamic changes in standing-up test of children and adolescents with postural tachycardia syndrome (POTS) and to compare hemodynamic parameters of POTS patients with decreased cardiac index (CI) and those with not-decreased CI. METHODS A retrospective study was conducted to show the trends of CI, total peripheral vascular resistance index (TPVRI), heart rate and blood pressure in standing-up test of 26 POTS patients and 12 healthy controls, and to compare them between the two groups. The POTS patients were divided into two groups based on CI decreasing or not in standing-up test, namely decreased CI group (14 cases) and not-decreased CI group (12 cases). The trends of the above mentioned hemodynamic parameters in standing-up test were observed and compared between decreased CI group and not-decreased CI group. RESULTS In standing-up test for all the POTS patients, CI (F=6.936, P=0.001) and systolic blood pressure (F=6.049, P<0.001) both decreased significantly, and heart rate increased obviously (F=113.926, P<0.001). However, TPVRI (F=2.031, P=0.138) and diastolic blood pressure (F=2.018, P=0.113) had no significant changes. For healthy controls, CI (F=3.646, P=0.016), heart rate (F=43.970, P<0.001), systolic blood pressure (F=4.043, P=0.020) and diastolic blood pressure (F=8.627, P<0.001) all increased significantly in standing-up test. TPVRI (F=1.688, P=0.190) did not change obviously. The changing trends of CI (F=6.221, P=0.001), heart rate (F=6.203, P<0.001) and systolic blood pressure (F=7.946, P<0.001) over time were significantly different between the patients and healthy controls, however, no difference was found in TPVRI and diastolic blood pressure (P > 0.05). Among the POTS patients, CI was significantly different between decreased CI group and not-decreased CI group (F=14.723, P<0.001). Systolic blood pressure of the former decreased obviously (F=8.010, P<0.001), but it did not change obviously in the latter (F=0.612, P=0.639). Furthermore, none of the changes of TPVRI, heart rate and diastolic blood pressure in standing-up test were significantly different between the two groups (P > 0.05). Age was an independent factor for decreased CI patients (P=0.013, OR=2.233; 95% CI, 1.183 to 4.216). CONCLUSION POTS patients experience vital hemodynamic changes in standing-up test, part of them suffering from decreased CI, but others from not-decreased CI. Age is an independent factor for patients suffering from decreased CI.
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Affiliation(s)
- C Y Tao
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - H X Li
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - X Y Li
- Department of Statistics, Peking University First Hospital, Beijing 100034, China
| | - C S Tang
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Beijing 100191, China
| | - H F Jin
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - J B DU
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China.,Key Laboratory of Molecular Cardiovascular Science, the Ministry of Education, Beijing 100191, China
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Kim JB, Hong S, Park JW, Cho DH, Park KJ, Kim BJ. Utility of corrected QT interval in orthostatic intolerance. PLoS One 2014; 9:e106417. [PMID: 25180969 PMCID: PMC4152255 DOI: 10.1371/journal.pone.0106417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 08/06/2014] [Indexed: 12/20/2022] Open
Abstract
We performed this study to determine whether electrocardiographic corrected QT (QTc) interval predicts alterations in sympathovagal balance during orthostatic intolerance (OI). We reviewed 1,368 patients presenting with symptoms suggestive of OI who underwent electrocardiography and composite autonomic function tests (AFTs). Patients with a positive response to the head-up tilt test were classified into orthostatic hypotension (OH), neurocardiogenic syncope (NCS), or postural orthostatic tachycardia syndrome (POTS) groups. A total of 275 patients (159 OH, 54 NCS, and 62 POTS) were included in the final analysis. Between-group comparisons of OI symptom grade, QTc interval, QTc dispersion, and each AFT measure were performed. QTc interval and dispersion were correlated with AFT measures. OH Patients had the most severe OI symptom grade and NCS patients the mildest. Patients with OH showed the longest QTc interval (448.8±33.6 msec), QTc dispersion (59.5±30.3 msec) and the lowest values in heart rate response to deep breathing (HRDB) (10.3±6.0 beats/min) and Valsalva ratio (1.3±0.2). Patients with POTS showed the shortest QTc interval (421.7±28.6 msec), the highest HRDB values (24.5±9.2 beats/min), Valsalva ratio (1.8±0.3), and proximal and distal leg sweat volumes in the quantitative sudomotor axon reflex test. QTc interval correlated negatively with HRDB (r = −0.443, p<0.001) and Valsalva ratio (r = −0.425, p<0.001). We found negative correlations between QTc interval and AFT values representing cardiovagal function in patients with OI. Our findings suggest that prolonged QTc interval may be considered to be a biomarker for detecting alterations in sympathovagal balance, especially cardiovagal dysfunction in OH.
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Affiliation(s)
- Jung Bin Kim
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Soonwoong Hong
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Jin-Woo Park
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Dong-Hyuk Cho
- Department of Cardiology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Ki-Jong Park
- Department of Neurology, Kyungsang University Medical Center, Jinjoo, Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
- * E-mail:
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P-wave dispersion: an indicator of cardiac autonomic dysfunction in children with neurocardiogenic syncope. Pediatr Cardiol 2014; 35:596-600. [PMID: 24633236 DOI: 10.1007/s00246-013-0825-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/03/2013] [Indexed: 10/26/2022]
Abstract
Neurocardiogenic syncope is the most frequent cause of fainting in childhood and adolescence. Although head-up tilt table testing (HUTT) was previously considered as the reference standard in the diagnosis of syncope, in children with a typical history of reflex syncope, normal physical examination, and electrocardiogram (ECG) are sufficient to cease investigation; however, according to recent reports, TT is indicated in patients in whom this diagnosis cannot be proven by initial evaluation. The hypothesis of this study is that P-wave dispersion (PWD) can be a useful electrocardiographic predictor of cardiac autonomic dysfunction in children with vasovagal syncope (VVS). The study was designed prospectively and included 50 children with positive and 50 children with negative HUTT who presented with at least two previous unexplained episodes of syncope as well as 50 sex- and age-matched healthy children as the control group. All standard 12-lead ECGs were obtained in patients and controls, and the difference between maximum and minimum durations of the P wave was defined as the PWD. A total of 100 children with VVS and 50 healthy controls were evaluated for the study. The P maximum values of HUTT-positive (HUTT[+]) patients were significantly greater than those in the HUTT-negative (HUTT[-]) and control groups(p < 0.05). In addition, mean PWD values were 50.2 ± 18.5, 39.6 ± 11.2 and 32.0 ± 11.2 ms in the HUTT(+), HUTT(-), and control groups, respectively. The difference between groups was statistically significant (p < 0.05). We suggest that PWD is an early sign of cardiac autonomic dysfunction in children with neurally mediated syncope and can be used as a noninvasive electrocardiographic test to evaluate orthostatic intolerance syndromes.
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Yang J, Zhao J, Du S, Liu D, Fu C, Li X, Chen S, Tang C, Du J, Jin H. Postural orthostatic tachycardia syndrome with increased erythrocytic hydrogen sulfide and response to midodrine hydrochloride. J Pediatr 2013; 163:1169-73.e2. [PMID: 23726544 DOI: 10.1016/j.jpeds.2013.04.039] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 04/03/2013] [Accepted: 04/22/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the use of erythrocytic hydrogen sulfide (H2S) in predicting the therapeutic efficacy of midodrine hydrochloride for children with postural orthostatic tachycardia syndrome (POTS). STUDY DESIGN Fifty-five children were included in this study, involving 28 children with POTS (POTS group) and 27 healthy children (control group). Children in the POTS group received midodrine hydrochloride treatment. Erythrocytic H2S production was measured; a receiver operating characteristic curve was used to assess if erythrocytic H2S could predict the therapeutic response to midodrine hydrochloride treatment. RESULTS H2S production from erythrocytes was significantly higher in the POTS group than in the control group (P < .01). H2S production was also significantly higher in responders to midodrine hydrochloride than in non-responders (P < .05). The change in symptom score and baseline erythrocytic H2S production had a positive linear relationship (P < .01). There was also a positive correlation with the change in heart rate (P < .05). The receiver operating characteristic curve showed an area under curve value of 0.813. Erythrocytic H2S production yielded a sensitivity of 78.9% and a specificity of 77.8% in predicting the efficacy of midodrine hydrochloride therapy for children with POTS. CONCLUSION Erythrocytic H2S could serve as a useful predictor of therapeutic response to midodrine hydrochloride in children with POTS.
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Affiliation(s)
- Jinyan Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, PR China
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