Heart Rate Variability Predicts Therapeutic Response to Metoprolol in Children With Postural Tachycardia Syndrome

Frontiers in Neuroscience

Chunyu Zhang¹  Yuli Wang¹  Ping Liu¹  Junbao Du²  Chaoshu Tang²  Selena Chen³  Yuanyuan Wang⁵  Hongfang Jin⁵ 

[1] Department of Pediatrics, Peking University First Hospital, Beijing, China;Department of Physiology and Pathophysiology, Health Sciences Centre, Peking University, Beijing, China;Division of Biological Sciences, University of California, San Diego, San Diego, CA, United States;Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China;Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China;

关键词: heart rate variability;    children;    postural tachycardia syndrome;    metoprolol;    therapy;   

DOI  :  10.3389/fnins.2019.01214

来源: DOAJ

【 摘 要 】

PurposeTo improve the metoprolol therapeutic effectiveness, we aimed to explore whether baseline heart rate variability (HRV) indicators before metoprolol treatment were useful for predicting its efficacy for postural tachycardia syndrome (POTS).MethodsWe recruited 45 children with POTS who received metoprolol and 17 healthy controls. All children underwent a standing test or basic head-up tilt test and 24-h dynamic electrocardiography before treatment. After 3 months of metoprolol, therapeutic responsiveness was evaluated. The usefulness of baseline HRV parameters in predicting the effectiveness of metoprolol was studied and the long-term cumulative symptom rate was analyzed.ResultsThe baseline HRV frequency domain indicators for power, ultra-low frequency, very-low frequency, low frequency (LF), high frequency (HF), and total power (TP) as well as time domain indicators were significantly lower for responders than non-responders to metoprolol; however, low-frequency normalized units and LF/HF ratio were markedly greater for responders than non-responders. On series-parallel analysis, combined baseline triangular (TR) index ≤ 33.7 and standard deviation of all normal-to-normal intervals (SDNN) index ≤ 79.0 ms as cut-off values yielded sensitivity, specificity and accuracy of 85.3, 81.8, and 84.4%, respectively, to predict therapeutic responsiveness to metoprolol. On long-term follow-up, the cumulative symptom rate was significantly higher with TR index > 33.7 and SDNN index ≤ 79.0 ms, TR index ≤ 33.7 and SDNN index > 79.0 ms or TR index > 33.7 and SDNN index > 79.0 ms than TR index ≤ 33.7 and SDNN index ≤ 79.0 ms (P < 0.05).ConclusionCombined TR index ≤ 33.7 and SDNN index ≤ 79.0 ms were useful preliminary measures to predict therapeutic response to metoprolol in pediatric POTS.

【 授权许可】

Unknown