Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-14T04:14:14.617Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  28 April 2014

Jing Lin
Affiliation:
Department of Pediatrics Peking University First Hospital, Beijing, China
Hongfang Jin
Affiliation:
Department of Pediatrics Peking University First Hospital, Beijing, China
Junbao Du*
Affiliation:
Department of Pediatrics Peking University First Hospital, Beijing, China
*
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: junbaodui@126.com

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.

Type
Review Articles
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Low, PA, Sandroni, P, Joyner, M, Shen, WK. Postural tachycardia syndrome (POTS). J Cardiovasc Electrophysiol 2009; 20: 352358.Google Scholar
2. Jarjour, IT. Postural tachycardia syndrome in children and adolescents. Semin Pediatr Neurol 2013; 20: 1826.Google Scholar
3. Stewart, JM. Common syndromes of orthostatic intolerance. Pediatrics 2013; 131: 968980.Google Scholar
4. Kenny, RA, Bhangu, J, King-Kallimanis, BL. Epidemiology of syncope/collapse in younger and older Western patient populations. Prog Cardiovasc Dis 2013; 55: 357363.Google Scholar
5. Medow, MS, Stewart, JM. The postural tachycardia syndrome. Cardiol Rev 2007; 15: 6775.CrossRefGoogle ScholarPubMed
6. Benarroch, EE. Postural tachycardia syndrome: a heterogeneous and multifactorial disorder. Mayo Clin Proc 2012; 87: 12141225.Google Scholar
7. Kanjwal, K, Karabin, B, Sheikh, M, et al. Pyridostigmine in the treatment of postural orthostatic tachycardia: a single-center experience. Pacing Clin Electrophysiol 2011; 34: 750755.CrossRefGoogle ScholarPubMed
8. Chen, L, Wang, L, Sun, J, et al. Midodrine hydrochloride is effective in the treatment of children with postural orthostatic tachycardia syndrome. Circ J 2011; 75: 927931.Google Scholar
9. Zhang, FW, Liao, Y, Li, XY, Chen, L, Jin, HF, DU, JB. Therapies for postural tachycardia syndrome in children. Zhonghua Er Ke Za Zhi 2011; 49: 428432.Google ScholarPubMed
10. Lai, CC, Fischer, PR, Brands, CK, et al. Outcomes in adolescents with postural orthostatic tachycardia syndrome treated with midodrine and beta-blockers. Pacing Clin Electrophysiol 2009; 32: 234238.Google Scholar
11. Fu, Q, Vangundy, TB, Shibata, S, Auchus, RJ, Williams, GH, Levine, BD. Exercise training versus propranolol in the treatment of the postural orthostatic tachycardia syndrome. Hypertension 2011; 58: 167175.CrossRefGoogle ScholarPubMed
12. Arnold, AC, Okamoto, LE, Diedrich, A, et al. Low-dose propranolol and exercise capacity in postural tachycardia syndrome: a randomized study. Neurology 2013; 80: 19271933.Google Scholar
13. Ross, AJ, Ocon, AJ, Medow, MS, Stewart, JM. A double-blind placebo-controlled cross-over study of the vascular effects of midodrine in neuropathic compared with hyperadrenergic postural tachycardia syndrome. Clin Sci (Lond) 2014; 126: 289296.CrossRefGoogle ScholarPubMed
14. Arnold, AC, Okamoto, LE, Diedrich, A, et al. Low-dose propranolol and exercise capacity in postural tachycardia syndrome: a randomized study. Neurology 2013; 80: 19271933.CrossRefGoogle ScholarPubMed
15. Fu, Q, Vangundy, TB, Shibata, S, Auchus, RJ, Williams, GH, Levine, BD. Exercise training versus propranolol in the treatment of the postural orthostatic tachycardia syndrome. Hypertension 2011; 58: 167175.Google Scholar
16. Vyas, A, Swaminathan, PD, Zimmerman, MB, Olshansky, B. Are treatments for vasovagal syncope effective? A meta-analysis. Int J Cardiol 2013; 167: 19061911.Google Scholar
17. Chen, L, DU, JB, Zhang, QY, et al. A multicenter study on treatment of autonomous nerve-mediated syncope in children with beta-receptor blocker. Zhonghua Er Ke Za Zhi 2007; 45: 885888.Google ScholarPubMed
18. Kuchinskaia, EA, Pevzner, AV, Vershuta, EV, et al. Comparative efficacy and tolerance of atenolol and midodrine in patients with vasovagal syncopes. Ter Arkh 2006; 78: 6468.Google ScholarPubMed
19. Liao, Y, Yang, J, Zhang, F, et al. Flow-mediated vasodilation as a predictor of therapeutic response to midodrine hydrochloride in children with postural orthostatic tachycardia syndrome. Am J Cardiol 2013; 112: 816820.CrossRefGoogle ScholarPubMed
20. Yang, J, Zhao, J, Du, S, et al. Postural orthostatic tachycardia syndrome with increased erythrocytic hydrogen sulfide and response to midodrine hydrochloride. J Pediatr 2013; 163: 11691173.CrossRefGoogle ScholarPubMed
21. Zhang, F, Li, X, Ochs, T, et al. Midregional pro-adrenomedullin as a predictor for therapeutic response to midodrine hydrochloride in children with postural orthostatic tachycardia syndrome. J Am Coll Cardiol 2012; 60: 315320.CrossRefGoogle ScholarPubMed
22. Jacob, G, Robertson, D, Mosqueda-Garcia, R, Ertl, AC, Robertson, RM, Biaggioni, I. Hypovolemia in syncope and orthostatic intolerance role of the renin-angiotensin system. Am J Med 1997; 103: 128133.Google Scholar
23. Lu, CC, Diedrich, A, Tung, CS, et al. Water ingestion as prophylaxis against syncope. Circulation 2003; 108: 26602665.Google Scholar
24. Mathias, CJ, Young, TM. Water drinking in the management of orthostatic intolerance due to orthostatic hypotension, vasovagal syncope and the postural tachycardia syndrome. Eur J Neurol 2004; 11: 613619.Google Scholar
25. El-Sayed, H, Hainsworth, R. Salt supplement increases plasma volume and orthostatic tolerance in patients with unexplained syncope. Heart 1996; 75: 134140.Google Scholar
26. Zhang, Q, Liao, Y, Tang, C, Du, J, Jin, H. Twenty-four-hour urinary sodium excretion and postural orthostatic tachycardia syndrome. J Pediatr 2012; 161: 281284.Google Scholar
27. Carew, S, Connor, MO, Cooke, J, et al. A review of postural orthostatic tachycardia syndrome. Europace 2009; 11: 1825.CrossRefGoogle ScholarPubMed
28. Grubb, BP. Postural tachycardia syndrome. Circulation 2008; 117: 28142817.CrossRefGoogle ScholarPubMed
29. Paling, D, Vilches-Moraga, A, Akram, Q, Atkinson, O, Staniland, JR, Paredes-Galán, E. Midodrine hydrochloride is safe and effective in older people with neurocardiogenic syncope. J Am Geriatr Soc 2010; 58: 20262027.Google Scholar
30. Chen, L, Du, JB, Jin, HF, et al. Effect of selective alpha1 receptor agonist in the treatment of children with postural orthostatic tachycardia syndrome. Zhonghua Er Ke Za Zhi 2008; 46: 688691.Google Scholar
31. Liao, Y, Chen, S, Liu, X, et al. Flow-mediated vasodilation and endothelium function in children with postural orthostatic tachycardia syndrome. Am J Cardiol 2010; 106: 378382.Google Scholar
32. Zhang, F, Li, X, Stella, C, et al. Plasma hydrogen sulfide in differential diagnosis between vasovagal syncope and postural orthostatic tachycardia syndrome in children. J Pediatr 2012; 160: 227231.Google Scholar
33. Tang, C, Li, X, Du, J. Hydrogen sulfide as a new endogenous gaseous transmitter in the cardiovascular system. Curr Vasc Pharmacol 2006; 4: 1722.Google Scholar
34. Geng, B, Yan, H, Zhong, GZ, et al. Hydrogen sulfide: a novel cardiovascular functional regulatory gas factor. Beijing Da Xue Xue Bao 2004; 36: 106.Google Scholar
35. Nishida, H, Horio, T, Suzuki, Y, et al. Plasma adrenomedullin as an independent predictor of future cardiovascular events in high-risk patients: comparison with C-reactive protein and adiponectin. Peptides 2008; 29: 599605.Google Scholar
36. Al-Omari, MA, Khaleghi, M, Mosley, TH Jr, et al. Mid-regional pro-adrenomedullin is associated with pulse pressure, left ventricular mass, and albuminuria in African Americans with hypertension. Am J Hypertens 2009; 22: 860866.Google Scholar
37. Struck, J, Tao, C, Morgenthaler, NG, Bergmann, A. Identification of an adrenomedullin precursor fragment in plasma of sepsis patients. Peptides 2004; 25: 13691372.CrossRefGoogle ScholarPubMed
38. Deng, W, Liu, Y, Liu, AD, et al. Difference between supine and upright blood pressure associates to the efficacy of midodrine on postural or thostatic tachycardia syndrome (POTS) in children. Pediatr Cardiol 2013; Epub ahead of print.Google Scholar
39. Zhang, QY, Du, JB, Zhen, JL, Li, WZ, Wang, YL. Hemodynamic changes during head-up tilt test and predictive value thereof in predicting the efficacy of metoprolol therapy in children with vasovagal syncope. Zhonghua Yi Xue Za Zhi 2007; 87: 12601262.Google ScholarPubMed