Prognostic Prediction Using Baseline Heart Rate and Head-Up Tilt Test Mode in Pediatric Cardioinhibitory Vasovagal...

Objectives: Clinically feasible simple methods for prognostic assessment of cardioinhibitory vasovagal syncope (VVS) are rare. This study investigated the predictive utility of head-up tile test (HUTT) data among cardioinhibitory VVS children with non-pharmacological therapy. Methods: A retrospective analysis was conducted on the clinical data of 403 children with VVS who had cardioinhibitory responses induced by HUTT. The children were aged 4-18 years old, including 178 males and 225 females. After the non-pharmacological interventions and follow-up, they were divided into the good prognosis group (233 cases) and the poor prognosis group (170 cases). Results: (1) Comparison between groups: Compared with the good prognosis group, the baseline heart rate (HR0) in the poor prognosis group was lower, and the proportion of sublingual nitroglycerin-provoked HUTT (SNHUT) was higher (p < 0.05). (2) Univariate analysis: Univariate analysis showed that HR0 was a protective factor on the prognosis of VVS, while SNHUT was a risk factor for the prognosis of VVS. (3) Multivariate analysis: HR0 was an independent protective factor on the prognosis of VVS. That is, for every 1 bpm increase in HR0, the risk of poor prognosis of VVS decreased by 3%. SNHUT was an independent risk factor for the prognosis of VVS, and the risk of poor prognosis of VVS increased by 3.34 times compared with basic HUTT (BHUT). (4) Evaluation of diagnostic tests: The combination of HR0 and HUTT mode had a good prognostic prediction effect for VVS (AUC = 0.71, p < 0.001). Conclusions: The combination of HR0 and HUTT mode demonstrates robust prognostic predictive value for non-pharmacological interventions in pediatric patients with VVS exhibiting cardioinhibitory responses during HUTT.