Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-19T11:52:26.146Z Has data issue: false hasContentIssue false
  • English
  • Français

Serum pyridoxine, folate, cobalamin, and homocysteine levels in children presenting with vasovagal syncope

Part of: Basic Science

Published online by Cambridge University Press:  29 July 2021

Tetiana Kovalchuk Open the ORCID record for Tetiana Kovalchuk [Opens in a new window]  and
Oksana Boyarchuk
Tetiana Kovalchuk*
Affiliation:
Department of Pediatrics # 2, Ivan Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
Oksana Boyarchuk
Affiliation:
Department of Pediatrics and Pediatric Surgery, Ivan Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
*
Author for correspondence: Dr. Tetiana Kovalchuk, Department of Pediatrics # 2, Ivan Horbachevsky Ternopil National Medical University, 1, Maydan Voli, Ternopil46001, Ukraine. Tel.: +380672536322. E-mail: tetianakovalchuk@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Recent studies confirm the role of B vitamins deficiency and hyperhomocysteinaemia in the development of dysautonomia that has been considered to be the main factor in vasovagal syncope development. The aim of the study was to investigate serum pyridoxine, folate, cobalamin, and homocysteine levels in children presenting with vasovagal syncope and to analyse the correlation between them and main clinical parameters of syncope.

Methods:

We studied 40 children, ages 8–17 years with a history of vasovagal syncope and 24 healthy volunteers. The serum pyridoxine, folate, cobalamin, and homocysteine levels were measured by a quantitative sandwich enzyme immunoassay technique using a commercial kit (Monobind, USA). Twenty-four-hour Holter monitoring and 24-hour ambulatory blood pressure monitoring were conducted for all participated patients.

Results:

Serum pyridoxine (9.42 ± 4.87, 16.11 ± 5.53 µg/L) and cobalamin (307.48 ± 95.50, 447.28 ± 108.85 ng/L) levels were reasonably low (p < 0.05) in patients with vasovagal syncope. Although there was no significant change in folate levels between syncope and healthy children (4.00 ± 1.34, 4.71 ± 1.73 µg/L; p = 0.20), we detected low folate-level association with longer duration of syncope (r = −0.42) and post syncope (r = −0.43) symptoms (p < 0.05). Finally, there was increased serum homocysteine level (13.55 ± 5.03, 7.81 ± 1.71 µmol/L; p < 0.05) in patients with vasovagal syncope. It was positively correlated with the average PQ interval (r = 0.35, p < 0.05) and average QTc interval (r = 0.49, p < 0.05).

Conclusions:

The results suggested that pyridoxine, folate, cobalamin, and homocysteine may be involved in the pathogenesis of vasovagal syncope. This might provide a new approach for effective treatment of paediatric vasovagal syncope, requiring further study.

Keywords

Vasovagal syncopepyridoxinefolatecobalaminhomocysteine
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 5 , May 2022 , pp. 762 - 768
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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

Friedman, KG, Alexander, ME. Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease. J Pediatr 2013; 163: 896.CrossRefGoogle Scholar
Brignole, M, Moya, A, de Lange, FJ, et al. 2018 ESC guidelines for the diagnosis and management of syncope. Eur Heart J 2018; 39: 1883–1948.CrossRefGoogle ScholarPubMed
Anderson, JB, Willis, M, Lancaster, H, Leonard, K, Thomas, C. The evaluation and management of pediatric syncope. Pediatr Neurol 2016; 55: 6–13.CrossRefGoogle ScholarPubMed
Grimaldi Capitello, T, Fiorilli, C, Placidi, S, Vallone, R, Drago, F, Gentile, S. What factors influence parents’ perception of the quality of life of children and adolescents with neurocardiogenic syncope? Health Qual Life Outcomes 2016; 14: 79.CrossRefGoogle ScholarPubMed
Kovalchuk, T. Validation of the Ukrainian version of the PedsQLTM 4.0 Generic Core Scales in children and adolescents with vasovagal syncope. Pediatr Pol 2020; 95: 112–120.CrossRefGoogle Scholar
Viswanathan, M, Treiman, KA, Kish-Doto, J, Middleton, JC, Coker-Schwimmer, EJL, Nicholson, WK. Folic acid supplementation for the prevention of neural tube defects: an updated evidence report and systematic review for the US preventive services task force. JAMA 2017; 317: 190–203.CrossRefGoogle ScholarPubMed
Kerr, MA, Livingstone, B, Bates, CJ, et al. Folate, related B vitamins, and homocysteine in childhood and adolescence: potential implications for disease risk in later life. Pediatrics 2009; 123: 627–635.CrossRefGoogle ScholarPubMed
Calderón-Ospina, CA, Nava-Mesa, MO. B Vitamins in the nervous system: current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin. CNS Neurosci Ther 2020; 26: 5–13.CrossRefGoogle ScholarPubMed
Moretti, R, Caruso, P. The controversial role of homocysteine in neurology: from labs to clinical practice. Int J Mol Sci 2019; 20: 231.CrossRefGoogle ScholarPubMed
Black, MM. Effects of vitamin B12 and folate deficiency on brain development in children. Food Nutr Bull 2008; 29: S126–S131.CrossRefGoogle ScholarPubMed
Nawaz, A, Khattak, NN, Khan, MS, Nangyal, H, Sabri, S, Shakir, M. Deficiency of vitamin B12 and its relation with neurological disorders: a critical review. JoBAZ 2020; 81: 10. doi: 10.1186/s41936-020-00148-0.CrossRefGoogle Scholar
Lee, DG, Lee, Y, Shin, H, et al. Seizures related to vitamin B6 deficiency in adults. J Epilepsy Res 2015; 5: 23–24.CrossRefGoogle ScholarPubMed
Altun, H, Şahin, N, Belge Kurutaş, E, Güngör, O. Homocysteine, pyridoxine, folate and vitamin B12 levels in children with attention deficit hyperactivity disorder. Psychiatr Danub 2018; 30: 310–316.CrossRefGoogle ScholarPubMed
Boldyrev, A, Bryushkova, E, Mashkina, A, Vladychenskaya, E. Why is homocysteine toxic for the nervous and immune systems? Curr Aging Sci 2013; 6: 29–36.CrossRefGoogle ScholarPubMed
Ganguly, P, Alam, SF. Role of homocysteine in the development of cardiovascular disease. Nutr J 2015; 14: 6.CrossRefGoogle ScholarPubMed
Pushpakumar, S, Kundu, S, Sen, U. Endothelial dysfunction: the link between homocysteine and hydrogen sulfide. Curr Med Chem 2014; 21: 3662–3672.CrossRefGoogle ScholarPubMed
Sanya, EO, Tutaj, M, Brown, CM, Goel, N, Neundörfer, B, Hilz, MJ. Abnormal heart rate and blood pressure responses to baroreflex stimulation in multiple sclerosis patients. Clin Auton Res 2005; 15: 213–218.CrossRefGoogle ScholarPubMed
Kayali, S, Gökcebay, DG. Influence of vitamin B12 deficiency on autonomic nervous system activity in children. Iran J Pediatr 2019; 29: e92634.CrossRefGoogle Scholar
Lambert, E, Lambert, GW. Sympathetic dysfunction in vasovagal syncope and the postural orthostatic tachycardia syndrome. Front Physiol 2014; 5: 280.CrossRefGoogle ScholarPubMed
Ganjehei, L, Massumi, A, Razavi, M, Wilson, JM. Orthostatic hypotension as a manifestation of vitamin B12 deficiency. Tex Heart Inst J 2012; 39: 722–723.Google ScholarPubMed
Usalp, S, Kemal, H, Yüksek, Ü, et al. Is there any link between vitamin D deficiency and vasovagal syncope? J Arrhythm 2020; 36: 371–376.CrossRefGoogle ScholarPubMed
Parekh, S, Sastry, BKS, Narasimhan, C, Arora, H. To study vitamin B12 deficiency and response to treatment in patients presenting with vasovagal syncope. J Cardiol 2018; 2: 000134.Google Scholar
Zou, R, Wang, S, Zhu, L, et al. Calgary score and modified Calgary score in the differential diagnosis between neurally mediated syncope and epilepsy in children. Neurol Sci 2017; 38: 143–149.CrossRefGoogle ScholarPubMed
Tanaka, H, Fujita, Y, Takenaka, Y, et al. Japanese clinical guidelines for juvenile orthostatic dysregulation version 1. Pediatr Int 2009; 51: 169–179.CrossRefGoogle ScholarPubMed
Parati, G, Stergiou, G, O’Brien, E, et al. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens 2014; 32: 1359–1366.CrossRefGoogle ScholarPubMed
Stover, PJ, Field, MS, Vitamin B-6. Adv Nutr 2015; 6: 132–133.CrossRefGoogle ScholarPubMed
Devalia, V, Hamilton, MS, Molloy, AM. British Committee for Standards in Haematology. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol 2014; 166: 496–513.CrossRefGoogle ScholarPubMed
Öner, T, Guven, B, Tavli, V, Mese, T, Yilmazer, MM, Demirpence, S. Postural orthostatic tachycardia syndrome (POTS) and vitamin B12 deficiency in adolescents. Pediatrics 2014; 133: e138–e142.CrossRefGoogle ScholarPubMed
Huemer, M, Vonblon, K, Födinger, M, et al. Total homocysteine, folate, and cobalamin, and their relation to genetic polymorphisms, lifestyle and body mass index in healthy children and adolescents. Pediatr Res 2006; 60: 764–769.CrossRefGoogle ScholarPubMed
Choi, JH, Yates, Z, Veysey, M, Heo, YR, Lucock, M. Contemporary issues surrounding folic Acid fortification initiatives. Prev Nutr Food Sci 2014; 19: 247–260.CrossRefGoogle ScholarPubMed
Hsu, CY, Chiu, SW, Hong, KS, et al. Folic acid in stroke prevention in countries without mandatory folic acid food fortification: a meta-analysis of randomized controlled trials. J Stroke 2018; 20: 99–109.CrossRefGoogle ScholarPubMed
Jardine, DL, Wieling, W, Brignole, M, Lenders, J, Sutton, R, Stewart, J. The pathophysiology of the vasovagal response. Heart Rhythm 2018; 15: 921–929.CrossRefGoogle ScholarPubMed
Benditt, DG, van Dijk, JG, Krishnappa, D, Adkisson, WO, Sakaguchi, S. Neurohormones in the pathophysiology of vasovagal syncope in adults. Front Cardiovasc 2020; 7: 76.CrossRefGoogle ScholarPubMed
Pektas, A, Koken, R, Koca, HB. Serum vitamin B-12 in children presenting with vasovagal syncope. Asia Pac J Clin Nutr 2018; 27: 176–181.Google ScholarPubMed
Finkelstein, JL, Layden, AJ, Stover, PJ. Vitamin B12 and perinatal health. Adv Nutr 2015; 6: 552–563.CrossRefGoogle ScholarPubMed
Kim, JB, Hong, S, Park, JW, Cho, DH, Park, KJ, Kim, BJ. Utility of corrected QT interval in orthostatic intolerance. PLoS One 2014; 9: e106417.CrossRefGoogle ScholarPubMed
Diedrich, A, Jordan, J, Shannon, JR, Robertson, D, Biaggioni, I. Modulation of QT interval during autonomic nervous system blockade in humans. Circulation 2002; 106: 2238–2243.CrossRefGoogle ScholarPubMed
Parra, M, Stahl, S, Hellmann, H. Vitamin B6 and its role in cell metabolism and physiology. Cells 2018; 7: 84.CrossRefGoogle ScholarPubMed
Spinneker, A, Sola, R, Lemmen, V, Castillo, M, Pietrzik, K, Gonzalez-Gross, M. Vitamin B6 status, deficiency and its consequences-an overview. Nutr Hosp 2007; 22: 7–24.Google Scholar
Allen, GFG, Neergheen, V, Oppenheim, M, et al. Pyridoxal 5′-phosphate deficiency causes a loss of aromatic l-amino acid decarboxylase in patients and human neuroblastoma cells, implications for aromatic l-amino acid decarboxylase and vitamin B6 deficiency states. J Neurochem 2010; 114: 87–96.Google Scholar
Jug, J, Bradić, L, Levicki, R, Benčić, ML. PR interval as a predictor of syncope in tilt-up testing in adolescents and young adults. Egypt Heart J 2021; 73: 28.CrossRefGoogle ScholarPubMed
Kovalchuk, T, Boyarchuk, O, Pavlyshyn, H, Balatska, N, Luchyshyn, N. Analysis of heart rate variability in paediatric patients with vasovagal syncope. Pediatr Pol 2019; 94: 357–367.Google Scholar
Li, Y, He, B, Li, H, et al. Plasma homocysteine level in children with postural tachycardia syndrome. Front Pediatr 2018; 6: 375.CrossRefGoogle ScholarPubMed
Azzini, E, Ruggeri, S, Polito, A. Homocysteine: its possible emerging role in at-risk population groups. Int J Mol Sci 2020; 21: 1421.CrossRefGoogle ScholarPubMed