Tilt angles and positive response of head-up tilt test in children with orthostatic intolerance

2013 ◽  
Vol 25 (1) ◽  
pp. 76-80 ◽  
Author(s):  
Jing Lin ◽  
Yuli Wang ◽  
Todd Ochs ◽  
Chaoshu Tang ◽  
Junbao Du ◽  
...  
Keyword(s):  
Tilt Angle ◽  
Positive Response ◽  
Orthostatic Intolerance ◽  
Vasovagal Syncope ◽  
Tilt Test ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Appearance Time ◽  
Significant Difference ◽  
Head Up Tilt ◽  
Head Up Tilt Test

AbstractThis study aimed at examining three tilt angle-based positive responses and the time to positive response in a head-up tilt test for children with orthostatic intolerance, and the psychological fear experienced at the three angles during head-up tilt test. A total of 174 children, including 76 boys and 98 girls, aged from 4 to 18 years old (mean 11.3±2.8 years old), with unexplained syncope, were randomly divided into three groups, to undergo head-up tilt test at the angles of 60°, 70° and 80°, respectively. The diagnostic rates and times were analysed, and Wong–Baker face pain rating scale was used to access the children’s psychological fear. There were no significant differences in diagnostic rates of postural orthostatic tachycardia syndrome and vasovagal syncope at different tilt angles during the head-up tilt test (p>0.05). There was a significant difference, however, in the psychological fear at different tilt angles utilising the Kruskal–Wallis test (χ2=36.398, p<0.01). It was mildest at tilt angle 60° utilising the Kolmogorov–Smirnov test (p<0.01). A positive rank correlation was found between the psychological fear and the degree of tilt angle (rs=0.445, p<0.01). Positive response appearance time was 15.1±14.0 minutes at 60° for vasovagal syncope children. There was no significant difference in the time to positive response, at different tilt angles during the head-up tilt test for vasovagal syncope or for postural orthostatic tachycardia syndrome. Hence, it is suggested that a tilt angle of 60° and head-up tilt test time of 45 minutes should be suitable for children with vasovagal syncope.

Assessment of therapeutic biomarkers in the treatment of children with postural tachycardia syndrome and vasovagal syncope

2014 ◽  
Vol 24 (5) ◽  
pp. 792-796 ◽  
Author(s):  
Jing Lin ◽  
Hongfang Jin ◽  
Junbao Du
Keyword(s):  
Orthostatic Intolerance ◽  
Vasovagal Syncope ◽  
Urinary Sodium Excretion ◽  
Tilt Test ◽  
Postural Tachycardia Syndrome ◽  
Postural Tachycardia ◽  
Ovid Medline ◽  
Head Up Tilt ◽  
Head Up Tilt Test ◽  
Flow Mediated Vasodilation

AbstractBackground: 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.

scholarly journals Orthostatic intolerance in adults with long COVID was not associated with postural orthostatic tachycardia syndrome

2021 ◽  
Author(s):  
Ann Monaghan ◽  
Glenn Jennings ◽  
Feng Xue ◽  
Lisa Byrne ◽  
Eoin Duggan ◽  
...  
Keyword(s):  
Daily Living ◽  
Orthostatic Intolerance ◽  
Cross Sectional Study ◽  
Tilt Test ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Sectional Study ◽  
Cross Sectional ◽  
Minute Post ◽  
Head Up Tilt ◽  
Head Up Tilt Test

In this observational cross-sectional study, we investigated predictors of orthostatic intolerance (OI) in adults with long COVID. Participants underwent a 3-minute active stand (AS) with Finapres NOVA, followed by a 10-minute unmedicated 70-degree head-up tilt test. 85 participants were included (mean age 46 years, range 25-78; 74% women), of which 56 (66%) reported OI during AS (OIAS). OIAS seemed associated with female sex, more fatigue and depressive symptoms, and greater inability to perform activities of daily living (ADL), as well as a higher heart rate (HR) at the lowest systolic blood pressure (SBP) point before the 1st minute post-stand (mean HRnadir: 88 vs 75 bpm, P=0.004). In a regression model also including age, sex, fatigue, depression, ADL inability, and peak HR after the nadir SBP, HRnadir was the only OIAS predictor (OR=1.09, 95% CI: 1.01-1.18, P=0.027). 22 participants had initial (iOH) and 5 classical (cOH) orthostatic hypotension, but neither correlated with OIAS. 71 participants proceeded to tilt, of which 28 had OI during tilt (OItilt). Of the 53 who had a 10-minute tilt, 7 (13%) fulfilled hemodynamic postural orthostatic tachycardia syndrome (POTS) criteria, but 6 did not report OItilt. OIAS was associated with a higher initial HR on AS, which after 1 minute equalized with the non-OIAS group. Despite these initial orthostatic HR differences, POTS was infrequent and largely asymptomatic. ClinicalTrials.gov Identifier: NCT05027724 (retrospectively registered on August 30, 2021).

scholarly journals The Application of Head-Up Tilt Test to Diagnose Hemodynamic Type of Orthostatic Intolerance in Children Aged Between 3 and 5 Years

2021 ◽  
Vol 9 ◽  
Author(s):  
Runmei Zou ◽  
Shuo Wang ◽  
Fang Li ◽  
Ping Lin ◽  
Juan Zhang ◽  
...  
Keyword(s):  
Autonomic Function ◽  
Orthostatic Intolerance ◽  
Medical Center ◽  
Vasovagal Syncope ◽  
Tilt Test ◽  
Sublingual Nitroglycerin ◽  
Positive Rate ◽  
Head Up Tilt ◽  
Head Up Tilt Test ◽  
Central South

Objectives: The head-up tilt test (HUTT) is a useful tool to assess autonomic function and to reproduce neurally mediated reflex. In this study, we evaluated the use of HUTT in pediatric patients aged 3–5 years with orthostatic intolerance.Materials and Methods: The medical history and HUTT records of 345 (180 males, aged from 3 to 5 years) cases of patients who complained of symptoms of orthostatic intolerance and who visited the Syncope Ward, Children's Medical Center, The Second Xiangya Hospital, Central South University from January 2003 to December 2019, were reviewed retrospectively.Results: Seventy-nine (22.9%) cases had positive responses to complete HUTT (basic HUTT and sublingual nitroglycerin HUTT), while 29 (8.4%) cases had positive responses if only basic HUTT was performed. Sublingual nitroglycerin provocation significantly increased the positive rate of the test (x2= 27.565, P &lt; 0.001). The most frequent hemodynamic response to HUTT was vasoinhibitory type vasovagal syncope (12.2%), Syncope (28.7%), and dizziness (22.6%) were the most common symptoms. Eight cases discontinued the test due to intolerable symptoms without severe adverse events occurring.Conclusions: HUTT was safe and well-tolerated and could be used to diagnose the hemodynamic type of orthostatic intolerance in children aged 3–5 years.

scholarly journals Age is a predictor for the recurrence of syncope in vasovagal syncope patients with a positive head-up tilt test

2019 ◽  
Author(s):  
Yongjuan Guo ◽  
Xiaomin Chen ◽  
Tianze Zeng ◽  
Lin Wang ◽  
Lvwei Cen
Keyword(s):  
Confidence Interval ◽  
Vasovagal Syncope ◽  
Predictive Performance ◽  
Tilt Test ◽  
Logistics Regression ◽  
Increased Risk ◽  
Significant Difference ◽  
Valid Predictor ◽  
Head Up Tilt ◽  
Head Up Tilt Test

Abstract BACKROUND Valid predictors of the recurrence of syncope in vasovagal syncope(VVS) patients with a positive head-up tilt test (HUTT) are currently lacking. The goal of this study was to identify the predictive performance of age for the recurrence of syncope in VVS patients with a positive HUTT.METHODS in total, 175 VVS patients with a positive HUTT were followed for 6 to 32 months, and ≥1 syncope episodes during follow-up was considered the recurrence of syncope. The study population was divided into 2 groups, namely, a recurrence of syncope group (44 patients) and a no recurrence of syncope group (131 patients). The baseline clinical data, hemodynamic parameters and classification of the vasovagal syncope on the HUTT were analyzed. Logistics regression was used to analyze the effect size and confidence interval of age. A receiver operating characteristic(ROC) analysis was used to assess the predictive performance and investigate the predictive value of age by the area under the curve (AUC).RESULTS The age of recurrence of syncope group 60.0 (47.8, 66.0) years was older than that of no recurrence of syncope group 53.0 (43.0, 62.0) years, and there was a significant difference between the two groups (P < 0.05). The trend of syncope recurrence changed with age and the logistics regression model adjusted by sex showed that the elder was an increased risk of syncope recurrence in VVS with positive HUTT [OR value: 1.03, 95% confidence interval(CI) 1.008 to 1.061 p < 0.05].Age was a valid predictor for the recurrence of syncope in VVS patients with a positive HUTT (AUC: 0.688; 95%CI 0.598 to 0.777 p < 0.05). The cut-off value was 53.5 years, and the sensitivity and specificity were 72.7% and 52.7%, respectively. CONCLUSIONS Age may be a valid predictor for recurrence of syncope in VVS patients with positive HUTT. The rate of recurrence of syncope increased with increasing age, especially in old female.

scholarly journals Age Is a Predictor for the Syncope Recurrence in Elderly Vasovagal Syncope Patients With a Positive Head-Up Tilt Test

2021 ◽  
Vol 8 ◽  
Author(s):  
Yongjuan Guo ◽  
Xiaomin Chen ◽  
Tianze Zeng ◽  
Lin Wang ◽  
Lvwei Cen
Keyword(s):  
Logistic Regression ◽  
Confidence Interval ◽  
Vasovagal Syncope ◽  
Predictive Performance ◽  
Tilt Test ◽  
Significant Difference ◽  
Valid Predictor ◽  
Head Up Tilt ◽  
Head Up Tilt Test ◽  
Recurrence Group

Background: Valid predictors of the syncope recurrence in vasovagal syncope (VVS) patients with a positive head-up tilt test (HUTT) are currently lacking. The goal of this study was to identify the predictive performance of age for the recurrence of syncope in VVS patients with a positive HUTT.Methods: In total, 175 VVS patients with a positive HUTT were observed for 6–32 months, and the recurrence of ≥1 syncope or typical pre-syncope prodromal episodes during follow-up was considered syncope recurrence. The population was divided into 2 groups, namely, a syncope recurrence group (44 patients) and a no syncope recurrence group (131 patients). The baseline clinical data, haemodynamic parameters, and classification of VVS on the HUTT were analyzed. Logistic regression was used to analyse the effect size and confidence interval for age. A receiver operating characteristic (ROC) curve analysis was used to assess the predictive performance and investigate the predictive value of age by the area under the curve (AUC).Results: The median age of the syncope recurrence group was older than that of the no syncope recurrence group [60.0 (47.8, 66.0) years&gt;53.0 (43.0, 62.0) years], and there was a significant difference between the two groups (P &lt; 0.05). The trend for syncope recurrence changed with advancing age, and the logistic regression model adjusted by sex showed that older patients had an increased risk of syncope recurrence in VVS with a positive HUTT [OR value: 1.03, 95% confidence interval (CI): 1.008–1.061, p &lt; 0.05]. Age was a valid predictor for the recurrence of syncope in elderly VVS patients with a positive HUTT (AUC: 0.688; 95% CI: 0.598–0.777, p &lt; 0.05). The cut-off value was 53.5 years, and the sensitivity and specificity were 72.7 and 52.7%, respectively.Conclusions: Age may be a valid predictor for syncope recurrence in elderly VVS patients with a positive HUTT. The rate of syncope recurrence increased with advancing age, especially in females.

scholarly journals Age is a predictor for the recurrence of syncope in vasovagal syncope patients with a positive head-up tilt test

2019 ◽  
Author(s):  
Yongjuan Guo ◽  
Xiaomin Chen ◽  
Tianze Zeng ◽  
Lin Wang ◽  
Lvwei Cen
Keyword(s):  
Confidence Interval ◽  
Vasovagal Syncope ◽  
Predictive Performance ◽  
Tilt Test ◽  
Logistics Regression ◽  
Increased Risk ◽  
Significant Difference ◽  
Valid Predictor ◽  
Head Up Tilt ◽  
Head Up Tilt Test

Abstract BACKROUND Valid predictors of the recurrence of syncope in vasovagal syncope (VVS) patients with a positive head-up tilt test (HUTT) are currently lacking. The goal of this study was to identify the predictive performance of age for the recurrence of syncope in VVS patients with a positive HUTT. METHODS in total, 175 VVS patients with a positive HUTT were followed for 6 to 32 months, and ≥1 syncope episodes during follow-up was considered the recurrence of syncope. The study population was divided into 2 groups, namely, a recurrence of syncope group (44 patients) and a no recurrence of syncope group (131 patients). The baseline clinical data, hemodynamic parameters and classification of the vasovagal syncope on the HUTT were analyzed. Binary logistics regression was used to analyze the effect size and confidence interval of age. A receiver operating characteristic(ROC) analysis was used to assess the predictive performance and investigate the predictive value of age by the area under the curve (AUC). RESULTS The age of recurrence of syncope group 60.0 (47.8, 66.0) years was older than that of no recurrence of syncope group 53.0 (43.0, 62.0) years, and there was a significant difference between the two groups (P < 0.05). The trend of syncope recurrence changed with age and the binary logistics regression model adjusted by sex showed that the elder was an increased risk of syncope recurrence in VVS with positive HUTT [OR value: 1.034, 95% confidence interval(CI) 1.008 to 1.061 p < 0.05].Age was a valid predictor for the recurrence of syncope in VVS patients with a positive HUTT (AUC: 0.688; 95%CI 0.598 to 0.777 p < 0.05) . The cut-off value was 53.5 years, and the sensitivity and specificity were 72.7% and 52.7%, respectively. CONCLUSIONS Age was a valid predictor for recurrence of syncope in VVS patients with positive HUTT. The rate of recurrence of syncope increased with increasing age, especially in old female.

Symptom Score: A New Instrument to Assess Orthostatic Intolerance in Children and Adolescents

2020 ◽  
Vol 35 (12) ◽  
pp. 835-843
Author(s):  
Hong Cai ◽  
Shuo Wang ◽  
Runmei Zou ◽  
Ping Liu ◽  
Hong Yang ◽  
...  
Keyword(s):  
Symptom Score ◽  
Orthostatic Intolerance ◽  
Vasovagal Syncope ◽  
Tilt Test ◽  
Postural Tachycardia Syndrome ◽  
Median Score ◽  
Postural Tachycardia ◽  
New Instrument ◽  
Head Up Tilt ◽  
Head Up Tilt Test

Objective: To develop an orthostatic intolerance symptom scoring system to assess orthostatic intolerance and then to compare the symptom score among different head-up tilt test responses. Methods: 272 subjects (5-18 years) presenting with orthostatic intolerance symptoms finished questionnaire and head-up tilt test. According to head-up tilt test hemodynamic responses, the subjects were divided into head-up tilt test negative, vasovagal syncope, and postural tachycardia syndrome groups. Results: We built up a symptom score according to the frequency of dizziness, headache, blurred vision, palpitations, chest discomfort, gastrointestinal symptoms, profuse perspiration, and syncope. The median score in postural tachycardia syndrome subjects was highest. A score of 2.5 for predicting vasovagal syncope yielded a sensitivity of 75.0% and specificity of 50.3%, a score of 5.5 for predicting postural tachycardia syndrome yielded a sensitivity of 69.7% and specificity of 72.0%. Furthermore, the median score in postural tachycardia syndrome subjects was significantly higher than that in head-up tilt test negative subjects with heart rate increment of 30-39 beats/min ( P < .01). Conclusions: This suggests that the symptom score has some predictive value in head-up tilt test results, which can be served as a preliminary assessment instrument.

scholarly journals Age is a predictor for the recurrence of syncope in vasovagal syncope patients with a positive head-up tilt test

2019 ◽  
Author(s):  
Yongjuan Guo ◽  
Xiaomin Chen ◽  
Tianze Zeng ◽  
Lin Wang ◽  
Lvwei Cen
Keyword(s):  
Confidence Interval ◽  
Vasovagal Syncope ◽  
Predictive Performance ◽  
Tilt Test ◽  
Logistics Regression ◽  
Increased Risk ◽  
Significant Difference ◽  
Valid Predictor ◽  
Head Up Tilt ◽  
Head Up Tilt Test

Abstract BACKROUND Valid predictors of the recurrence of syncope in vasovagal syncope (VVS) patients with a positive head-up tilt test (HUTT) are currently lacking. The goal of this study was to identify the predictive performance of age for the recurrence of syncope in VVS patients with a positive HUTT. METHODS in total, 175 VVS patients with a positive HUTT were followed for 6 to 32 months, and ≥1 syncope episodes during follow-up was considered the recurrence of syncope. The study population was divided into 2 groups, namely, a recurrence of syncope group (44 patients) and a no recurrence of syncope group (131 patients). The baseline clinical data, hemodynamic parameters and classification of the vasovagal syncope on the HUTT were analyzed. Binary logistics regression was used to analyze the effect size and confidence interval of age. A receiver operating characteristic(ROC) analysis was used to assess the predictive performance and investigate the predictive value of age by the area under the curve (AUC). RESULTS The age of recurrence of syncope group 60.0 (47.8, 66.0) years was older than that of no recurrence of syncope group 53.0 (43.0, 62.0) years, and there was a significant difference between the two groups (P < 0.05). The trend of syncope recurrence changed with age and the binary logistics regression model adjusted by sex showed that the elder was an increased risk of syncope recurrence in VVS with positive HUTT [OR value: 1.034, 95% confidence interval(CI) 1.008 to 1.061 p < 0.05].Age was a valid predictor for the recurrence of syncope in VVS patients with a positive HUTT (AUC: 0.688; 95%CI 0.598 to 0.777 p < 0.05) . The cut-off value was 53.5 years, and the sensitivity and specificity were 72.7% and 52.7%, respectively. CONCLUSIONS Age was a valid predictor for recurrence of syncope in VVS patients with positive HUTT. The rate of recurrence of syncope increased with increasing age, especially in old female.

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