International Journal of General Medicine (Mar 2022)
Poincaré Plot Can Be a Useful Tool to Select Potential Responders to Metoprolol Therapy in Children with Vasovagal Syncope
Abstract
Piaoliu Yuan,1 Xueying Li,2 Chunyan Tao,1 Xiaojuan Du,1 Chunyu Zhang,1 Junbao Du,1,3 Yaqian Huang,1 Ying Liao1 1Department of Pediatrics, Peking University First Hospital, Beijing, People’s Republic of China; 2Department of Medical Statistics, Peking University First Hospital, Beijing, People’s Republic of China; 3Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, People’s Republic of ChinaCorrespondence: Ying Liao; Yaqian Huang, Department of Pediatrics, Peking University First Hospital, Xi-An Men Street No. 1, West District, Beijing, 100034, People’s Republic of China, Tel +8610-83573238 ; +8610-83575807, Fax +8610-66530532, Email [email protected]; [email protected]: To explore the value of the longitudinal axis/transverse axis ratio (L/T) of Poincaré plot in selecting children with vasovagal syncope (VVS) who were suitable for metoprolol therapy.Patients and Methods: Children with VVS hospitalized in Peking University First Hospital between January 2012 and June 2019 and treated with metoprolol were retrospectively included as the training set, and children with VVS hospitalized between July 2019 and December 2020 were included as the validation set. The sex, age at admission, height, weight, body mass index, course of disease, syncope symptom score before metoprolol treatment, treatment duration, supine heart rate (HR), supine systolic pressure, supine diastolic pressure, peak HR during the head-up tilt test (HUTT), changes of HR during HUTT, hemodynamic response during HUTT, left ventricular ejection fraction, left ventricular fractional shortening and the L/T of Poincaré plot were compared between responders and nonresponders in the training set. Logistic regression analysis was conducted to explore predictors. Receiver operating characteristic curve was utilized to determine the value of the predictors for selecting potential responders. Finally, the value of the predictors was further verified.Results: In the training set including 105 children, the L/T in responders was distinctly higher than that in nonresponders (P 2.7 yielded a sensitivity of 88.2% and a specificity of 82.8% for indicating responders to metoprolol. Taking L/T > 2.7 to select potential responders in another 43 children with VVS in the validation set, the sensitivity was 96.6%, specificity 71.4%, and accuracy 88.4%.Conclusion: The L/T of Poincaré plot > 2.7 can be a useful tool to select potential responders to metoprolol therapy in children with VVS.Keywords: Poincaré plot, metoprolol, vasovagal syncope, children, Holter
