Key result
Combined baseline TR index ≤ 33.7 and SDNN index ≤ 79.0 ms predicted therapeutic responsiveness to metoprolol in pediatric POTS with 85.3% sensitivity and 81.8% specificity.
Why the study?
To explore whether baseline heart rate variability indicators prior to metoprolol treatment can predict its therapeutic efficacy in pediatric postural tachycardia syndrome.
Do baseline heart rate variability indicators predict therapeutic response to metoprolol in children with postural tachycardia syndrome?
Cohort (n=62)
Do baseline heart rate variability indicators predict therapeutic response to metoprolol in children with postural tachycardia syndrome?
Baseline heart rate variability parameters, specifically combined TR index and SDNN index, can accurately predict therapeutic response to metoprolol in pediatric POTS.
May aid metoprolol responder selection in pediatric POTS; leaves open randomized confirmation before practice change.
Purpose: To improve the metoprolol therapeutic effectiveness, we aimed to explore whether baseline heart rate variability (HRV) indicators before metoprolol treatment were useful for predicting its efficacy for postural tachycardia syndrome (POTS). Methods: We recruited 45 children with POTS who received metoprolol and 17 healthy controls. All children underwent a standing test or basic head-up tilt test and 24-hr dynamic electrocardiography before treatment. After 3 months of metoprolol, therapeutic responsiveness was evaluated. The usefulness of baseline HRV parameters in predicting the effectiveness of metoprolol was studied and the long-term cumulative symptom rate was analyzed. Results: The baseline HRV frequency domain indicators for power, ultra-low frequency, very-low frequency, low frequency (LF), high frequency (HF), high frequency normalized units and total power (TP) as well as time domain indicators were significantly lower for responders than non-responders to metoprolol; however, low-frequency normalized units and LF/HF ratio were markedly greater for responders than non-responders. On series-parallel analysis, combined baseline triangular (TR) index ≤ 33.7 and standard deviation of all normal-to-normal intervals (SDNN) index ≤ 79.0 ms as cut-off values yielded sensitivity, specificity and accuracy of 85.3%, 81.8% and 84.4%, respectively, to predict therapeutic responsiveness to metoprolol. On long-term follow-up, the cumulative symptom rate was significantly higher with TR index > 33.7 and SDNN index ≤ 79.0 ms, TR index ≤ 33.7 and SDNN index > 79.0 ms or TR index > 33.7 and SDNN index > 79.0 ms than TR index ≤ 33.7 and SDNN index ≤ 79.0 ms (P<0.05). Conclusion: Combined TR index ≤ 33.7 and SDNN index ≤ 79.0 ms were useful preliminary measures to predict therapeutic response to metoprolol in pediatric POTS.
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Wang et al. (2019) conducted a cohort in Postural tachycardia syndrome (POTS) (n=62). Baseline heart rate variability (HRV) indicators vs. Non-responders was evaluated on Therapeutic responsiveness to metoprolol. Combined baseline TR index ≤ 33.7 and SDNN index ≤ 79.0 ms predicted therapeutic responsiveness to metoprolol in pediatric POTS with 85.3% sensitivity and 81.8% specificity.
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