Key result
A T/L ratio greater than 0.3 on a 24-hour Holter Poincaré plot distinguished vasovagal syncope from postural tachycardia syndrome with an AUC of 0.953, yielding 91.0% sensitivity and 90.5% specificity.
Why the study?
To explore the role of the Poincare plot derived from a 24-hour Holter recording in distinguishing vasovagal syncope from postural tachycardia syndrome in pediatric patients.
Does the Poincaré plot derived from a 24-hour Holter recording accurately distinguish vasovagal syncope from postural tachycardia syndrome in pediatric patients?
Observational (n=284)
No
Does the Poincaré plot derived from a 24-hour Holter recording accurately distinguish vasovagal syncope from postural tachycardia syndrome in pediatric patients?
The T/L ratio from a 24-hour Holter Poincaré plot provides high sensitivity and specificity for distinguishing vasovagal syncope from postural tachycardia syndrome in pediatric patients.
May support Holter Poincaré plots to differentiate pediatric VVS from POTS; leaves open prospective validation before any practice change.
Objectives: To explore the role of the Poincaré plot derived from a 24-hour Holter recording in distinguishing vasovagal syncope (VVS) from postural tachycardia syndrome (POTS) in pediatric patients. Materials and Methods: Pediatric patients with VVS or POTS, hospitalized in Peking University First Hospital between January 2012 and December 2018, were included in a derivation study. The transverse axis (T), longitudinal axis (L), T/L ratio, product T × L, distance between the origin and the proximal end of the longitudinal axis (pro-D), and distance between the origin and distal end of the longitudinal axis (dis-D) of the Poincaré plot were compared between the VVS and POTS groups, and the differential diagnostic performance of the above-mentioned graphic parameters was evaluated using receiver operating characteristic curve analysis. A validation study was conducted in pediatric patients hospitalized between January 2019 and December 2020. Results: In school-aged children, the T, L, T/L, T × L, and dis-D values of patients with VVS were greater than those of patients with POTS; in adolescents, the T, T/L, T × L, and pro-D values of patients with VVS were greater than those of patients with POTS. Using a T/L cut-off value of 0.3 to distinguish between the two diseases, the sensitivity and specificity were 91.0 and 90.5%, respectively, for the total participants; 91.6 and 88.9%, respectively, for the school-aged children; and 82.1 and 95.7%, respectively, for the adolescents. In the validation study, a T/L cut-off value of 0.3 yielded an accuracy, sensitivity, and specificity of 81.8, 87.2, and 77.6%, respectively, in the total participants; 76.5, 82.6, and 71.4%, respectively, in the school-aged children; and 89.2, 93.8, and 85.7%, respectively, in the adolescents, in distinguishing VVS from POTS validated by clinical diagnosis. Conclusions: The graphic parameters of the Poincaré plot are significantly different between VVS and POTS in pediatric patients, and the T/L of the Poincaré plot may be a useful measure to help differentiate VVS from POTS in children and adolescents.
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Yuan et al. (2022) conducted an observational in Vasovagal syncope and postural tachycardia syndrome (n=284). T/L ratio of Poincaré plot > 0.3 vs. T/L ratio of Poincaré plot ≤ 0.3 was evaluated on Distinguishing VVS from POTS (AUC 0.953, 95% CI 0.925-0.982, p=<0.001). A T/L ratio greater than 0.3 on a 24-hour Holter Poincaré plot distinguished vasovagal syncope from postural tachycardia syndrome with an AUC of 0.953, yielding 91.0% sensitivity and 90.5% specificity.
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