Plasma human growth cytokines in children with vasovagal syncope

The Correlation and Predictive Value of Prognostic Nutrition Index with Vasovagal Syncope in Children

To investigate the correlation between prognostic nutritional index (PNI) and vasovagal syncope (VVS) in children, as well as its predictive value. 151 children (68 males, aged 4-18 years) diagnosed with VVS due to unexplained syncope and presyncope in our hospital from January 2022 to December 2023 were the study group, 152 healthy children (72 males, aged 7-14 years) who underwent physical examination in the same hospital during the same period of time were matched as the control group. Serum albumin (SA), serum globulin (SG), albumin/globulin (AGR), and peripheral blood lymphocyte absolute count (Lc) were measured, and PNI was calculated. ①PNI (51.35 vs. 55.28), SA (40.90 g/L vs. 43.05 g/L), AGR (1.65 vs. 1.75), and Lc (2.08 × 109/L vs. 2.49 × 109/L) were decreased in VVS group compared with control group (P < 0.05). ②Predictive analysis of VVS by PNI: The area under receiver operator characteristic curve of PNI prediction of VVS was 0.814, which indicated that PNI had moderate predictive value for VVS diagnosis. When PNI cutoff value was 55.00, the sensitivity, specificity, and Youden index of predicting VVS were 90.73%, 54.61%, and 0.45, respectively. ③PNI (OR = 0.65, 95%CI: 0.58-0.74, P < 0.001) is also as an independent protective factor for VVS. PNI is correlated with VVS in children, holds predictive value for the diagnosis of pediatric VVS, and serves as an independent protective factor for VVS occurrence in children.

Guidelines for the diagnosis and treatment of neurally mediated syncope in children and adolescents (revised 2024)

BACKGROUND

Significant progress has been made in the diagnosis and treatment of pediatric syncope since the publication of the "2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents" ("2018 Edition Guidelines"). Therefore, we have revised and updated it to assist pediatricians in effectively managing children with syncope.

DATA SOURCES

According to the "2018 Edition Guidelines", the expert groups collected clinical evidence, evaluated preliminary recommendations, and then organized open-ended discussions to form the recommendations. This guideline was developed by reviewing the literature and studies in databases including PubMed, Cochrane, EMBASE, China Biomedical Database, and Chinese Journal Full-text Database up to April 2024. Search terms included "syncope", "children", "adolescents", "diagnosis", and "treatment."

RESULTS

The guidelines were based on the latest global research progress and were evidence-based. The classification of syncope etiology, diagnostic procedures, postural tests, such as the active standing test, head-up tilt test, and active sitting test, clinical diagnosis, and individualized treatment for neurally mediated syncope in pediatric population were included.

CONCLUSIONS

The guidelines were updated based on the latest literature. The concepts of sitting tachycardia syndrome and sitting hypertension were introduced and the comorbidities of neurally mediated syncope were emphasized. Some biomarkers used for individualized treatment were underlined. Specific suggestions were put forward for non-pharmacological therapies as well as the follow-up process. The new guidelines will provide comprehensive guidance and reference for the diagnosis and treatment of neurally mediated syncope in children and adolescents.

Relationship between syncopal symptoms and head-up tilt test modes

OBJECTIVE

Head-up tilt test (HUTT) is an important tool in the diagnosis of pediatric vasovagal syncope. This research will explore the relationship between syncopal symptoms and HUTT modes in pediatric vasovagal syncope.

METHODS

A retrospective analysis was performed on the clinical data of 2513 children aged 3-18 years, who were diagnosed with vasovagal syncope, from Jan. 2001 to Dec. 2021 due to unexplained syncope or pre-syncope. The average age was 11.76 ± 2.83 years, including 1124 males and 1389 females. The patients were divided into the basic head-up tilt test (BHUT) group (596 patients) and the sublingual nitroglycerine head-up tilt test (SNHUT) group (1917 patients) according to the mode of positive HUTT at the time of confirmed pediatric vasovagal syncope.

RESULTS

(1) Baseline characteristics: Age, height, weight, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and composition ratio of syncope at baseline status were higher in the BHUT group than in the SNHUT group (all P < 0.05). (2) Univariate analysis: Age, height, weight, HR, SBP, DBP, and syncope were potential risk factors for BHUT positive (all P < 0.05). (3) Multivariate analysis: syncope was an independent risk factor for BHUT positive, with a probability increase of 121% compared to pre-syncope (P<0.001).

CONCLUSION

The probability of BHUT positivity was significantly higher than SNHUT in pediatric vasovagal syncope with previous syncopal episodes.

Efficacy of catheter ablation in ganglionated plexus for malignant vasovagal syncope children

AIM

Malignant vasovagal syncope in children seriously affects their physical and mental health. Our study aimed to explore the efficacy of catheter ablation in ganglionated plexus with malignant vasovagal syncope children.

CONCLUSION

Catheter ablation of ganglionated plexus was safe and effective in children with malignant vasovagal syncope and can be used as a treatment option for these children.

METHODS

A total of 20 children diagnosed with malignant vasovagal syncope were enrolled in Beijing Children's Hospital, affiliated with Capital Medical University. All underwent catheter ablation treatment of ganglionated plexus. Ganglionated plexuses of the left atrium were identified by high-frequency stimulation and/or anatomic landmarks being targeted by radiofrequency catheter ablation. The efficacy of the treatment was evaluated by comparing the remission rate of post-operative syncopal symptoms and the rate of negative head-up tilt results. Safety and adverse events were evaluated.

RESULTS

After follow-up for 2.5 (0.6-5) years, the syncope symptom scores were decreased significantly compared with before treatment [3 (2-4) versus 5 (3-8) scores, P < 0.01]. Eighty-five per cent (17/20) children no longer experienced syncope, whilst 80% (16/20) children showed negative head-up tilt test after treatment. No adverse effects such as cardiac arrhythmia occurred in the children.

Relationship between hemodynamic type and syncopal symptoms in pediatric vasovagal syncope

Vasovagal syncope (VVS) is a clinically common neurally mediated syncope. The relationship between different hemodynamic types of VVS and clinical syncopal symptoms has not been reported. The purpose of this research is to explore relationship between hemodynamic types and syncopal symptoms in pediatric VVS. Two thousand five hundred thirteen patients diagnosed with VVS at the age of 3-18 years, average age was 11.76 ± 2.83 years, including 1124 males and 1389 females, due to unexplained syncope and pre-syncope from single-center of January 2001 to December 2021 were retrospectively analyzed. Subjects were divided into two groups according to the presence or absence of syncopal symptoms: syncope group (1262 cases) and pre-syncope group (1251 cases). (1) Baseline characteristics: age, height, weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP) increased in the syncope group compared with the pre-syncope group; the composition ratio of females was more than that of males in the syncope group; and the composition ratio of VVS-cardioinhibited (VVS-CI) and VVS-mixed (VVS-M) was more in the syncope group than that of the pre-syncope group (all P < 0.05). (2) Univariate analysis: age, height, weight, SBP, DBP, female, VVS-CI, and VVS-M were potential risk factors for the presence of syncopal symptoms (all P < 0.05). (3) Multivariate analysis: VVS-CI and VVS-M were independent risk factors for the presence of syncopal symptoms, with an increased probability of 203% and 175%, respectively, compared to VVS-vasoinhibited (VVS-VI) (all P < 0.01).

CONCLUSION

The hemodynamic type of pediatric VVS is closely related to the syncopal symptoms.

WHAT IS KNOWN

• There are varying probabilities of syncopal episodes in different hemodynamic types of VVS, and there is a lack of research to assess the comparative risk of syncope in children with different hemodynamic types of VVS.

WHAT IS NEW

• The probability in presence of syncopal symptoms varies greatly between different hemodynamic types of VVS. • VVS-CI and VVS-M had a 203% and 175% increased risk in presence of syncopal symptoms compared with VVS-VI, respectively.

Application of mind map can promote the health education effect of children with vasovagal syncope

Objective

To explore the effect of mind map on health education in children with vasovagal syncope (VVS).

Methods

In this prospective controlled study, 66 children with VVS (29 males, 10.38 ± 1.80 years) and their parents (12 males, 39.27 ± 3.74 years) who were hospitalized in the Department of Pediatrics, The Second Xiangya Hospital, Central South University from April 2020 to March 2021 were set as the control group. 66 children with VVS (26 males, 10.29 ± 1.90 years) and their parents (9 males, 38.65 ± 1.99 years) who were hospitalized in the same hospital from April 2021 to March 2022 were set as the research group. Traditional oral propaganda method was applied in the control group, and the health education method based on mind map was applied in the research group. The self-designed VVS health education satisfaction questionnaire and comprehensive health knowledge questionnaire were used to conduct on-site return visits to the children and their parents who had been discharged from the hospital for 1 month.

Results

There was no significant difference in age, sex, hemodynamic type of VVS, and the parental age, sex, education level between the control group and the research group (P > 0.05). Health education satisfaction score, health education knowledge mastery score, compliance score, subjective efficacy and objective efficacy in the research group were higher than those in the control group (P < 0.05). If the satisfaction score, knowledge mastery score, and compliance score increase by 1 point, the risk of poor subjective efficacy is reduced by 48, 91, and 99%, respectively, and the risk of poor objective efficacy is reduced by 44, 92, and 93%, respectively.

Conclusions

Application of mind map can improve the health education effect of children with VVS.