Several questions of head-up tilt test in the Children with neurally mediated syncope / 国际儿科学杂志

Neurally mediated syncope (NMS)is common in pediatric emergency and intensive care unit.Head-up tilt test(HUTT)has been widely used as an valuable diagnostic tools for NMS,while the results would be affected by multiple factors.Controversies still exist on issues such as the influence factors of positive rate,complication and clinical predictions of the HUTT.In this review,several problems in the application of HUTT in NMS of children are reviewed.

Comparison of curative effect and serum electrolytes between different oral rehydration salts in treatment of neurally mediated syncope children / 中南大学学报(医学版)

Objective:To compare the curative effect and the changes of serum electrolytes between oral rehydration salts (ORS) Ⅰ and ORS Ⅲ treatment in neurally mediated syncope children.Methods:The children with the symptom of unexplained syncope and pre-syncope were collected in Second Xiangya Hospital from May 2014 to May 2017.After head-up tilt test (HUTT),their serum electrolytes levels were examined.Children who were positive in the HUTT received ORS (ORS Ⅰ or ORS Ⅲ) and health education.Subjects were randomly divided into an ORS Ⅰ group (n=27) and an ORS Ⅲ group (n=49).Results:There was no statistical significance in sex,age,height,body mass,initial diagnosis and re-diagnosis interval between the 2 groups (P＞0.05);the total efficiency after ORS Ⅲ and ORS Ⅰ treatment were 79.59％ and 62.96％,respectively,with no statistical significance (x2=2.483,P＞0.05);the HUTT negative conversion rate after ORS Ⅲ and ORS Ⅰ treatment were 51.02％ and 48.16％,respectively,with no statistical significance (x2=0.058,P＞0.05);before treatment,the serum sodium [(140.20±2.26) mmol/L vs (138.39±2.72) mmol/L;t=2.856,P＜0.05] in the ORS Ⅲ group was higher than that in the ORS Ⅰ group,the serum phosphorus [(1.46±0.19) mmol/L vs (1.65±0.29) mmol/L;t=3.146,P＜0.05] in the ORS Ⅲ group was lower than that in the ORS Ⅰ group;after treatment,the serum sodium [(140.31±2.01) mmol/L vs (138.88±2.08) mmol/L;t=2.692,P＜0.05] and serum calcium [(2.31±0.09) mmol/L vs (2.24±0.11) mmol/L;t=2.696,P＜0.05] in the ORS Ⅲ group were higher than those in the ORS Ⅰ group,the serum phosphorus [(1.45±0.16) mmol/L vs (1.61±0.25) mmol/L;t=3.128,P＜0.05] in the ORS Ⅲ group was lower than that in the ORS Ⅰ group;after ORS Ⅲ treatment,there was no statistical significance in serum electrolytes between HUTT positive group and HUTT negative group (P＞0.05);after ORS Ⅰ treatment,the serum calcium [(2.29±0.10) mmol/L vs (2.19±0.10) mmol/L;t=2.501,P＜0.05]and serum phosphorus [(1.71±0.24) mmol/L vs (1.50±0.21) mmol/L;t=2.392,P＜0.05] in HUTT positive group were higher than those in HUTT negative group.There was no statistical significance in serum sodium,potassium,magnesium,and chloride (P＞0.05);there was no statistical significance in serum electrolytes between pre-treatment and post-treatment in the ORS Ⅰ group and the ORS Ⅲ group (P＞0.05);there was no statistical significance in serum electrolytes between vasovagal syncope and postural orthostatic tachycardia syndrome in the ORS Ⅰ group and the ORS Ⅲ group before ORS treatment (P＞0.05).Conclusion:The ORS Ⅲ and ORS Ⅰ have the similar efficacy in the treatment of children with neurally mediated syncope.ORS Ⅲ is easier to be accepted by children than ORS Ⅰ,with better compliance.

Role of Baroreflex Sensitivity in Predicting Tilt Training Response in Patients with Neurally Mediated Syncope

PURPOSE: An association between baroreflex sensitivity (BRS) and the response to tilt training has not been reported in patients with neurally mediated syncope (NMS). This study sought to investigate the role of BRS in predicting the response to tilt training in patients with NMS. MATERIALS AND METHODS: We analyzed 57 patients who underwent tilt training at our hospital. A responder to tilt training was defined as a patient with three consecutive negative responses to the head-up tilt test (HUT) during tilt training. RESULTS: After tilt training, 52 patients (91.2%) achieved three consecutive negative responses to the HUT. In the supine position before upright posture during the first session of tilt training for responders and non-responders, the mean BRS was 18.17+/-10.09 ms/mm Hg and 7.99+/-5.84 ms/mm Hg (p=0.008), respectively, and the frequency of BRS > or =8.945 ms/mm Hg was 45 (86.5%) and 1 (20.0%; p=0.004), respectively. Age, male gender, frequency of syncopal events before HUT, type of NMS, phase of positive HUT, total number of tilt training sessions, and mean time of tilt training did not differ between the study groups. In the multivariate analysis, BRS <8.945 ms/mm Hg in the supine position (odds ratio 23.10; 95% CI 1.20-443.59; p=0.037) was significantly and independently associated with non-response to tilt training. CONCLUSION: The BRS value in the supine position could be a predictor for determining the response to tilt training in patients with NMS who are being considered for inpatient tilt training.

Changes in serum and urine electrolytes of children with neurally mediated syncope after oral rehydration salts [Ⅰ]treatment / 中华实用儿科临床杂志

Objective To explore the changes in serum and urine electrolytes of children with neurally media-ted syncope (NMS)after oral rehydration salts (ORS)[Ⅰ]treatment.Methods The study group included 135 patients [60 male and 75 female,aged 4 -16 years,average of (10.20 ±2.68)years old]with unexplained syncope and prodro-mal symptoms of syncope in our hospital between May 2014 and April 2015.The patients underwent head -up tilt test (HUTT),and completed serum electrolytes and 24 -hour urine electrolytes,and the serum electrolytes and 24 -hour u-rine electrolytes in different hemodynamic type of HUTT were compared.Positive HUTT patients were treated with health education and ORS[Ⅰ],while negative HUTT patients were received health education.Then 21 -154(42.63 ±27.71) days later,the patients returned to hospital,for the inquiry of symptom improvement,and review of HUTT,24 -hour urine and serum electrolytes.Results (1)The total effective rate of ORS[Ⅰ]treatment was 62.96% (17 /27 cases),while negative conversion rate of HUTT was 48.15% (13 /27 cases).(2)There was no significant difference in serum electro-lytes,24 -hour urine electrolytes or 24 -hour urine volume between HUTT positive group and negative group during the first visit (all P >0.05).(3)In return visit,serum calcium [(2.30 ±0.10)mmol/L vs (2.20 ±0.09)mmol/L,t =2.72,P 0.05).(4)24 -hour urine sodium [(159.06 ±72.76)mmol/24 h vs (118.97 ±52.75)mmol/24 h,t =2.712,P 0.05).(5)There was no significant difference in serum elec-trolytes,24 -hour urine electrolytes or 24 -hour urine volume between vasovagal syncope group and postural orthostatic tachycardia syndrome group during the first visit(all P >0.05).Conclusions ORS[Ⅰ]treatment can obviously increase the 24 -hour urine sodium,24 -hour urine chloride in children with NMS.ORS[Ⅰ]is an effective therapy for NMS.

The changes of ventricular late potentials in patients with neurally mediated syncope / 中国小儿急救医学

Neurally mediated syncope children have autonomic nervous system dysfunction.Ventricular late potentials is closely related to the autonomic nerve function and is an index for predicting the occurrence of malignant arrhythmia.Understanding the changes of ventricular late potentials have a certain value in predicting cardiovascular disease of neurally mediated syncope children.

The research progress of oral rehydration salts treating neurally mediated syncope in children / 中国小儿急救医学

Neurally mediated syncope (NMS) is the most common children unexplained syncope.Oral rehydration salts is the basis for the treatment of NMS.Oral rehydration salts can increase the extracellular fluid and blood volume,change the redistribution of blood,avoid the emptying effect caused by inadequate left ventricular filling volume when position changes suddenly,prevent increased vagus nerve activity induced syncope,can obviously increase the NMS children's ability of orthostatic intolerance.Increase water salt intake can be incorporated into the behavior training of the NMS children's daily life,and it can reduce the occurrence rate of NMS children,and improve the quality of life.

Características e resultados do teste de inclinação na população sintomática: [revisão] / Characteristcs and results of tilt table testing in symptomatic population: [review] / Características y resultados de la prueba de inclinación en la población sintomática: [revisión]

Síncope é um sintoma de prevalência significativa na população geral e possui prognóstico variável de acordo com sua etiologia. O teste de inclinação ou Tilt-teste é um exame útil na investigação dos pacientes com Síncope, Hipotensão Postural e Disautonomia e trata-se de um exame já rotineiro em nosso meio. Objetivo: Analisar o índice de positividade do exame, além dos seus tipos de respostas mais comuns, e a necessidade do uso da sensibilização com dinitrato de isossorbida no auxílio do diagnóstico. Material e métodos: Entre o período de março de 2005 a junho de 2009, foram avaliados 348 pacientes submetidos ao Tilt-teste, dentre os quais, 244(70,1%) pacientes eram do sexo feminino com idade média de 36 anos. Resultados: O Tilt-teste foi negativo em 163(46,8%) pacientes. Nos exames positivos, o tipo mais comum de resposta foi a vasodepressora em 113(32,47%) pacientes, seguido pela resposta mista em 56(16,1%) pacientes e cardioninibiotória em 14(4%) pacientes. Dois pacientes apresentaram quadros de Disautonomia e Síndrome da Taquicardia Postural Ortostática (POTS). O tempo médio para positivação dos exames foi de 28 minutos após início da ortostase, sendo que, em 166(89,72%) pacientes, foi necessário uso de sensibilização com dinitrato de isossorbida por via sublingual. Conclusão: Na população estudada, observamos que o Tilt-teste foi positivo em 53,2% dos casos. Dentre esses pacientes, a forma mais comum de resposta da síncope neurocardiogênica foi a vasodepressora em 113 pacientes, sendo que o uso da sensibilização foi necessário em quase 90% dos pacientes na positivação dos exames.

Syncope is a symptom of significant prevalence in the general population and has changeable prognostic in accordance with its etiology. The inclination test or Tilt table test is a useful examination in the investigation of patients with syncope, postural hypotension and disautonomy and it is a routine examination already in our way. Objective: To analyze the positive rate of the exam, in addition to its most common types of response and the need of sensitization with isosorbide dinitrate to aid the diagnosis. Material and methods: 348 patients submitted to Tilt table test were evaluated between March of 2005 and June of 2009, 244 (70.1%) females at the mean age of 36 years. Results: The Tilt table test was negative in 163 (46.8%) patients. In the positive exams the most common type of response was the vasodepressor in 113 (32.47%) patients, followed by the mixed response in 56 (16.1%) patients and cardioinhibitory in 14 (4%) patients. Two patients had history of disautonomy and Postural Ortostatic Tachycardia Syndrome (POTS). The average time for positivation of the examinations was of 28 minutes after the beginning of the ortostasis, in 166 (89.72%) patients the use of sensitization with isosorbide dinitrate via sublingual was necessary. Conclusion: In the studied population weobserve that the Tilt table test was positive in 53,2% of the cases. Among these patients the most common response of neurocardiogenic syncope was the vasodepressor in 113 patients and the use of the sensitization was necessary in almost 90% of the patients in the positivation of the examinations.

Síncope es un síntoma de prevalencia significativa en la población general y tiene pronóstico variable de acuerdo con su etiología. La prueba de inclinación o Tilt-test es un examen útilen la investigación de los pacientes con Síncope, Hipotensión Postural y Disautonomia y ya se trata de un examen de rutina en nuestro medio. Objetivo: Analizar el índice de positividad del examen, además de sus tipos de respuestas más comunes, y la necesidad del uso de la sensibilización con dinitrato de isosorbida para ayudar el diagnóstico. Material y métodos: Entre el período de marzo de 2005 y junio de 2009, se evaluaron a 348 pacientes sometidos al Tilt-test, entre los cuales, 244 (70,1%) pacientes eran del sexo femenino con edad media de 36 años. Resultados: El Tilt-test fue negativo en 163 (46,8%) pacientes. En los exámenes positivos, el tipo más común de respuesta fue la vasodepresora en 113 (32,47%) pacientes, seguido de la respuesta mixta en 56 (16,1%) pacientes y cardioinhibitoria en 14 (4%) pacientes. Dos pacientes presentaron cuadros de Disautonomia y Síndrome de Taquicardia Postural Ortostática (POTS). El tiempo medio para positivación de losexámenes foi de 28 minutos tras el inicio de la ortostasis, siendo que, en 166 (89,72%) pacientes, fuenecesario el uso de sensibilización con dinitrato de isosorbida por vía sublingual. Conclusión: En la población estudiada, observamos que el Tilt-test fue positivo en el 53,2% de los casos. Entre dichos pacientes, la forma más común de respuesta del síncope neurocardiogénico fue la vasodepresora en 113 pacientes, siendo que el uso de la sensibilización fue necesario en casi el 90% de los pacientes en la positivación de los exámenes.

Gender Difference in Patients with Recurrent Neurally Mediated Syncope

PURPOSE: The gender difference of neurally mediated syncope is not well defined in a large patient population. The aim of this study was to evaluate the gender difference of clinical manifestations in patients with neurally mediated syncope who underwent head-up tilt test. MATERIALS AND METHODS: The medical records of 1,051 consecutive patients with two or more episodes of syncope, who were diagnosed as having neurally mediated syncope by head-up tilt test, were retrospectively reviewed. RESULTS: Of 1,051 patients, 497 (47.3%) patients were male and 554 (52.7%) patients were female. Female patients were experiencing syncopal episodes for longer periods of their lives (8.2 +/- 9.5 years vs. 6.8 +/- 9.2 years, p = 0.002) and more episodes of syncope prior to head-up tilt test (HUT) (7.2 +/- 9.4 vs. 5.0 +/- 6.4, p = 0.001) than male patients. Micturition syncope (20.0% vs. 5.2%, p < 0.001) was observed more frequently in male patients than in female patients. To the contrary, however, defecation syncope (16.3% vs. 9.3%, p < 0.001) was observed more frequently in female patients than in male patients. CONCLUSION: Female patients were experiencing syncopal episodes for longer periods of their lives and more episodes of syncope than male patients. Gender difference was also noted with regard to frequency of situational syncope.

Reprodutibilidade do teste de inclinação em pacientes com síncope neurocardiogênica / Reproducibility of Hecid-Up Tilt Test in Patients with Neurally Mediated Syncope

PURPOSE--In order to identify the reproducibility of head-up tilt test, a second test one week later in 22 patients with a positive first test, was performed. METHODS--The test was performed in a fasting state during the morning. The heart rate and blood pressure were monitored during 20 minutes in the supine position and then at 60 degrees for up to 40 minutes. The test were considered positive if the patient experienced syncope or pre-syncope with fall in systolic blood pressure > 30mmHg. The following aspects were evaluated: reproducibility of the positive response; the type of response (hypotension, asystole or hypotension plus bradycardia) and the time interval between tilt and the beginning of symptoms. RESULTS--Eighteen (82 per cent) patients had a second positive response; 14 (77.8 per cent) of then had the same type of response; and 17 (94 per cent) had syncope in similar time interval after tilt. CONCLUSION--The head-up tilt testing has good reproducibility, although its use in the therapeutic management needs a longer period of evaluation