Poincaré Plot Is Useful for Distinguishing Vasovagal Syncope From Postural Tachycardia Syndrome in Children

Frontiers in Pediatrics

article

Piaoliu Yuan¹  Zhouhui Lian²  Yuanyuan Wang¹  Yaru Wang¹  Chunyu Zhang¹  Junbao Du¹  Yaqian Huang¹  Ying Liao¹ 

[1] Department of Pediatrics, Peking University First Hospital;Wang Xuan Institute of Computer Science, Peking University;Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education

关键词: Poincaré plot;    vasovagal syncope;    postural tachycardia syndrome;    children;    orthostatic intolerance;    syncope;    Holter;    Lorenz-RR scatterplot;   

DOI  :  10.3389/fped.2022.758100

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

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.

【 授权许可】

CC BY