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Baroreflex Sensitivity Predicts Short-Term Outcome of Postural Tachycardia Syndrome in Children
Hongxia Li1, Ying Liao1, Yuli Wang1
1Department of Pediatrics, Peking University First Hospital, Beijing, P. R. China.
Insights
Baroreflex sensitivity (BRS) can predict short-term outcomes in children with postural tachycardia syndrome (POTS). Higher BRS levels in POTS patients indicate a poorer prognosis, suggesting BRS as a valuable predictive tool.
Area of Science:
- Pediatric Cardiology
- Autonomic Nervous System Disorders
- Clinical Physiology
Background:
- Postural tachycardia syndrome (POTS) is a complex autonomic disorder affecting children, characterized by an excessive heart rate increase upon standing.
- Assessing the short-term prognosis of POTS in pediatric populations is crucial for timely intervention and management.
- Baroreflex sensitivity (BRS), a measure of the heart rate response to blood pressure changes, has emerged as a potential biomarker in cardiovascular and autonomic research.
Purpose of the Study:
- To investigate the predictive capability of baroreflex sensitivity (BRS) for the short-term clinical outcome in pediatric patients diagnosed with postural tachycardia syndrome (POTS).
- To establish whether BRS measurements can differentiate between POTS patients with varying degrees of symptom improvement over a 90-day follow-up period.
Main Methods:
- A cohort of 77 children, including 45 with POTS and 32 healthy controls, underwent a 90-day follow-up.
- Continuous hemodynamic monitoring and BRS assessment were performed using the Finapres Medical System.
- POTS patients were categorized into subgroups based on symptom score changes, and receiver-operating characteristic (ROC) curve analysis was employed to evaluate BRS predictive value.
Main Results:
- Children with POTS exhibited significantly higher BRS compared to healthy controls (18.76±9.96 ms/mmHg vs 10±5.42 ms/mmHg, P<0.01).
- Patients with less symptom improvement (subgroup B) demonstrated higher BRS than those with significant improvement (subgroup A) (24.7±9.9 ms/mmHg vs 13.5±6.6 ms/mmHg, P <0.01).
- A BRS cut-off value of 17.01 ms/mmHg achieved 85.7% sensitivity and 87.5% specificity in predicting short-term POTS outcomes, with an Area Under the Curve (AUC) of 0.855.
Conclusions:
- Baroreflex sensitivity (BRS) serves as a valuable and reliable index for predicting the short-term prognosis of postural tachycardia syndrome (POTS) in pediatric patients.
- The findings suggest that BRS measurement can aid clinicians in stratifying risk and tailoring treatment strategies for children with POTS.
Objective:
The study was designed to examine if baroreflex sensitivity (BRS) could predict the short-term outcome of postural tachycardia syndrome (POTS) in children.
Methods:
Seventy-seven children subjects were included in the study. Among them, 45 children were in the POTS group and another 32 healthy children were in the control group. A ninety-day clinical follow-up was conducted and the symptom score before and after the follow-up was calculated for POTS patients by using POTS score system. Hemodynamics and continuous BRS monitoring were recorded by Finapres Medical System-FMS (FinometerPRO, FMS Company, Netherlands). According to the symptom score change during follow-up period, POTS patients were further divided into subgroup A (n = 24) with symptom score decreased by at least two points and subgroup B (n = 21) with symptom score decreased by less than two points. The predictive value of BRS in the short-term outcome of POTS in children was analyzed using receiver-operating characteristic (ROC) curve.
Results:
BRS of POTS children was significantly higher than that of the healthy children (18.76±9.96 ms/mmHg vs 10±5.42 ms/mmHg, P<0.01). It was higher in subgroup B than that of subgroup A (24.7±9.9 ms/mmHg vs 13.5±6.6 ms/mmHg, P <0.01). BRS was positively correlated with HR change in POTS Group (r = 0.304, P <0.05). Area under curve (AUC) was 0.855 (95% of confidence interval 0.735-0.975), and BRS of 17.01 ms/mmHg as a cut-off value yielded the predictive sensitivity of 85.7% and specificity of 87.5%.
Conclusions:
BRS is a useful index to predict the short-term outcome of POTS in children.
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