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Poincaré Plot Is Useful for Distinguishing Vasovagal Syncope From Postural Tachycardia Syndrome in Children
Piaoliu Yuan1, Zhouhui Lian2, Yuanyuan Wang1
1Department of Pediatrics, Peking University First Hospital, Beijing, China.
Insights
The Poincaré plot
Area of Science:
- Cardiology
- Pediatric Medicine
- Autonomic Dysfunction
Background:
- Distinguishing vasovagal syncope (VVS) from postural tachycardia syndrome (POTS) in pediatric patients is clinically challenging.
- Both conditions significantly impact quality of life in children and adolescents.
Purpose of the Study:
- To evaluate the utility of Poincaré plot parameters derived from 24-hour Holter recordings in differentiating VVS from POTS in pediatric populations.
- To identify specific Poincaré plot metrics that can aid in the differential diagnosis.
Main Methods:
- A retrospective study involving pediatric patients diagnosed with VVS or POTS.
- Analysis of Poincaré plot parameters including transverse axis (T), longitudinal axis (L), and their ratio (T/L).
- Receiver operating characteristic (ROC) curve analysis was used to assess diagnostic performance, with a validation cohort.
Main Results:
- Significant differences in Poincaré plot parameters were observed between VVS and POTS groups in both school-aged children and adolescents.
- A T/L ratio cut-off of 0.3 demonstrated high sensitivity and specificity in distinguishing VVS from POTS across age groups in the derivation and validation cohorts.
- The T/L ratio showed promising accuracy in differentiating these conditions in pediatric patients.
Conclusions:
- Poincaré plot parameters, particularly the T/L ratio, are valuable tools for differentiating VVS from POTS in pediatric patients.
- This non-invasive method can assist clinicians in the accurate diagnosis and management of pediatric autonomic dysfunction.
Objectives:
To explore the role of the Poincaré plot derived from a 24-hour Holter recording in distinguishing vasovagal syncope (VVS) from postural tachycardia syndrome (POTS) in pediatric patients.
Materials And Methods:
Pediatric patients with VVS or POTS, hospitalized in Peking University First Hospital between January 2012 and December 2018, were included in a derivation study. The transverse axis (T), longitudinal axis (L), T/L ratio, product T × L, distance between the origin and the proximal end of the longitudinal axis (pro-D), and distance between the origin and distal end of the longitudinal axis (dis-D) of the Poincaré plot were compared between the VVS and POTS groups, and the differential diagnostic performance of the above-mentioned graphic parameters was evaluated using receiver operating characteristic curve analysis. A validation study was conducted in pediatric patients hospitalized between January 2019 and December 2020.
Results:
In school-aged children, the T, L, T/L, T × L, and dis-D values of patients with VVS were greater than those of patients with POTS; in adolescents, the T, T/L, T × L, and pro-D values of patients with VVS were greater than those of patients with POTS. Using a T/L cut-off value of 0.3 to distinguish between the two diseases, the sensitivity and specificity were 91.0 and 90.5%, respectively, for the total participants; 91.6 and 88.9%, respectively, for the school-aged children; and 82.1 and 95.7%, respectively, for the adolescents. In the validation study, a T/L cut-off value of 0.3 yielded an accuracy, sensitivity, and specificity of 81.8, 87.2, and 77.6%, respectively, in the total participants; 76.5, 82.6, and 71.4%, respectively, in the school-aged children; and 89.2, 93.8, and 85.7%, respectively, in the adolescents, in distinguishing VVS from POTS validated by clinical diagnosis.
Conclusions:
The graphic parameters of the Poincaré plot are significantly different between VVS and POTS in pediatric patients, and the T/L of the Poincaré plot may be a useful measure to help differentiate VVS from POTS in children and adolescents.
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