Cardiology in the Young (2014), 24, 792–796
© Cambridge University Press, 2014
doi:10.1017/S1047951114000316
Review Article Assessment of therapeutic biomarkers in the treatment of children with postural tachycardia syndrome and vasovagal syncope Jing Lin, Hongfang Jin, Junbao Du Department of Pediatrics Peking University First Hospital, Beijing, China Abstract Background: Postural tachycardia syndrome and vasovagal syncope are common causes of orthostatic intolerance in children. The supplementation with water, or salt, or midodrine, or β-blocker was applied to children with postural tachycardia syndrome or vasovagal syncope. However, the efficacy of such medication varied and was not satisfied. This review aimed to summarise the current biomarkers in the treatment of the diseases. Data sources: Studies were collected from online electronic databases, including OVID Medline, PubMed, ISI Web of Science, and associated references. The main areas assessed in the included studies were clinical improvement, the cure rate, and the individualised treatment for postural tachycardia syndrome and vasovagal syncope in children. Results: Haemodynamic change during head-up tilt test, and detection of 24-hour urinary sodium excretion, flow-mediated vasodilation, erythrocytic H2S, and plasma pro-adrenomedullin as biological markers were the new ways that were inexpensive, non-invasive, and easy to test for finding those who would be suitable for a specific drug and treatment. Conclusion: With the help of biomarkers, the therapeutic efficacy was greatly increased for children with postural tachycardia syndrome and vasovagal syncope. Keywords: Postural tachycardia syndrome; vasovagal syncope; therapeutic biomarkers Received: 31 October 2013; Accepted: 7 February 2014; First published online: 28 April 2014
O
RTHOSTATIC INTOLERANCE IS A CONSTELLATION
of signs and symptoms that are elicited by standing upright and relieved by recumbency.1 Postural tachycardia syndrome and vasovagal syncope are main entities of orthostatic intolerance in children. Postural tachycardia syndrome is defined by symptoms of orthostatic intolerance in association with excessive tachycardia.2 Its symptoms include palpitations, light headedness, chest discomfort, shortness of breath, blurred vision, and exercise intolerance.2,3 Postural tachycardia syndrome is more frequent in female patients and most cases occur from the age 15 to 25 years old. Chronic fatigue, chronic headache, fibromyalgia, and sleep disturbances have been frequently associated with postural tachycardia Correspondence to: J. Du, Department of Pediatrics Peking University First Hospital, Xi'an Street No.1, Xicheng District, Beijing 100034, China. Tel: + 86-10-83573238; Fax: + 86-10-65530532; E-mail: [email protected]
syndrome. Physical deconditioning and psychological factors play an important role in these patients. Some individuals with serious symptoms were unable to participate in the school studies or the social activities. One-third of medical students report at least one syncopal episode in their life-time.4
Treatment status of postural tachycardia syndrome and vasovagal syncope The mechanisms for those diseases have been unclear yet. Absolute hypovolemia, hyper-adrenergic responses, imbalance in the autonomic nervous system, and impaired regulation of peripheral vascular resistance were thought to be involved in the pathogenesis.5 Therefore, the supplementation with water, or salt, or midodrine, or β-blockers was applied to children with postural tachycardia syndrome or vasovagal syncope; even the pyridostigmine or octreotide was sometimes
Vol. 24, No. 5
793
Lin et al: Treatment of POTS and VVS
Orthostatic Intolerance
VVS
POTS
Increment of heart beat more than 30 beat/min before positive presponse during head-up test
FMD⭌9.85%
Erythrocytic H2S ⭌27.1 nmol/min/108 erythrocytes
MR-proADM >61.5 pg/ml
Increment of SBP⬉0 mmHg or DBP⬉6.5 mmHg from supine to standing
24-hour urinary sodium
© Cambridge University Press, 2014
doi:10.1017/S1047951114000316
Review Article Assessment of therapeutic biomarkers in the treatment of children with postural tachycardia syndrome and vasovagal syncope Jing Lin, Hongfang Jin, Junbao Du Department of Pediatrics Peking University First Hospital, Beijing, China Abstract Background: Postural tachycardia syndrome and vasovagal syncope are common causes of orthostatic intolerance in children. The supplementation with water, or salt, or midodrine, or β-blocker was applied to children with postural tachycardia syndrome or vasovagal syncope. However, the efficacy of such medication varied and was not satisfied. This review aimed to summarise the current biomarkers in the treatment of the diseases. Data sources: Studies were collected from online electronic databases, including OVID Medline, PubMed, ISI Web of Science, and associated references. The main areas assessed in the included studies were clinical improvement, the cure rate, and the individualised treatment for postural tachycardia syndrome and vasovagal syncope in children. Results: Haemodynamic change during head-up tilt test, and detection of 24-hour urinary sodium excretion, flow-mediated vasodilation, erythrocytic H2S, and plasma pro-adrenomedullin as biological markers were the new ways that were inexpensive, non-invasive, and easy to test for finding those who would be suitable for a specific drug and treatment. Conclusion: With the help of biomarkers, the therapeutic efficacy was greatly increased for children with postural tachycardia syndrome and vasovagal syncope. Keywords: Postural tachycardia syndrome; vasovagal syncope; therapeutic biomarkers Received: 31 October 2013; Accepted: 7 February 2014; First published online: 28 April 2014
O
RTHOSTATIC INTOLERANCE IS A CONSTELLATION
of signs and symptoms that are elicited by standing upright and relieved by recumbency.1 Postural tachycardia syndrome and vasovagal syncope are main entities of orthostatic intolerance in children. Postural tachycardia syndrome is defined by symptoms of orthostatic intolerance in association with excessive tachycardia.2 Its symptoms include palpitations, light headedness, chest discomfort, shortness of breath, blurred vision, and exercise intolerance.2,3 Postural tachycardia syndrome is more frequent in female patients and most cases occur from the age 15 to 25 years old. Chronic fatigue, chronic headache, fibromyalgia, and sleep disturbances have been frequently associated with postural tachycardia Correspondence to: J. Du, Department of Pediatrics Peking University First Hospital, Xi'an Street No.1, Xicheng District, Beijing 100034, China. Tel: + 86-10-83573238; Fax: + 86-10-65530532; E-mail: [email protected]
syndrome. Physical deconditioning and psychological factors play an important role in these patients. Some individuals with serious symptoms were unable to participate in the school studies or the social activities. One-third of medical students report at least one syncopal episode in their life-time.4
Treatment status of postural tachycardia syndrome and vasovagal syncope The mechanisms for those diseases have been unclear yet. Absolute hypovolemia, hyper-adrenergic responses, imbalance in the autonomic nervous system, and impaired regulation of peripheral vascular resistance were thought to be involved in the pathogenesis.5 Therefore, the supplementation with water, or salt, or midodrine, or β-blockers was applied to children with postural tachycardia syndrome or vasovagal syncope; even the pyridostigmine or octreotide was sometimes
Vol. 24, No. 5
793
Lin et al: Treatment of POTS and VVS
Orthostatic Intolerance
VVS
POTS
Increment of heart beat more than 30 beat/min before positive presponse during head-up test
FMD⭌9.85%
Erythrocytic H2S ⭌27.1 nmol/min/108 erythrocytes
MR-proADM >61.5 pg/ml
Increment of SBP⬉0 mmHg or DBP⬉6.5 mmHg from supine to standing
24-hour urinary sodium
