Heart rate variability indices in children with syncope due to orthostatic hypotension
DOI:
https://doi.org/10.11603/bmbr.2706-6290.2022.1.12671Keywords:
syncope due to orthostatic hypotension, heart rate variability, autonomic nervous system, childrenAbstract
Summary. Orthostatic hypotension (OH) in children may be accompanied by symptoms such as dizziness and syncope and is often a manifestation of baroreflex failure due to autonomic imbalance. Heart rate variability (HRV) is one of the most effective methods of assessing the modulation of the autonomic nervous system and its balance.
The aim of the study – to learn the features of autonomic nervous system modulation in children with syncope due to OH using HRV parameters.
Materials and Methods. Twenty-five children aged 8–17 with a diagnosis of syncope due to OH and 41 practically healthy children were examined. The diagnostic criteria of the European Society of Cardiology (ESC 2018) were used to diagnose syncope due to OH. All patients were provided with accurate history taking, physical examination, active standing test, electrocardiography in 12 leads, echocardiography, electroencephalography and 24-hour Holter monitoring for HRV assessment.
Results. There were no differences in values of HRV parameters SDANN, RMSSD and pNN50 in children with syncope due to OH compared to healthy ones (p<0.05). These results generally indicate the normal activity of humoral influences and central oscillators against the background of balanced parasympathetic effects on the cardiovascular system in children with syncope. However, there were increased TP (10502.59±1526.62 ms2; 5482.44±396.87 ms2; p=0.0016), VLF (5768.27±774.29 ms2; 3906.29±269.09 ms2; p=0.046) and LF/HF ratio (1.75±0.18; 1.29 ± 0.09; p=0.044) in the group of syncope due to OH. Correlations were found between the number of syncope events and SDANN (r=-0.62; p=0.002), and RMSSD (r=-0.46; p=0.03), duration of the last presyncope event and VLF (r=0.44; p =0.04), duration of the last syncope event and LF/HF ratio (r=0.57; p=0.006), 24-hour average interval PQ duration and SDANN (r=0.64; p=0.001), and RMSSD (r=0.63; p=0.002), 24-hour average interval QT duration and SDANN (r=0.43; p=0.04), and RMSSD (r=0.43; p=0.05) in patients with syncope due to OH.
Conclusions. In children with syncope due to OH markers of pathological autonomic regulation are HRV parameters TP, VLF, and LF/HF ratio, and their increase values is evidence of predominance of the sympathetic circuit of heart rate regulation against the background of increased baroreflex activity of the heart and impaired adaptive-compensatory capabilities of the cardiovascular system including the activity of the central circuits of heart rate regulation.
References
Figueroa JJ, Basford JR, Low PA. Preventing and treating orthostatic hypotension: As easy as A, B, C. Cleve Clin J Med. 2010;77(5): 298-306. Available from: https://doi.org/10.3949/ccjm.77a.09118
Magkas N, Tsioufis C, Thomopoulos C, Dilaveris P, Georgiopoulos, G, Sanidas E, et al. Orthostatic hypotension: From pathophysiology to clinical applications and therapeutic considerations. J Clin Hypertens (Greenwich). 2019;21(5): 546-54. Available from: https://doi.org/10.1111/jch.13521
Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E., Biaggioni I, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2): 69-72. Available from: https://doi.org/10.1007/s10286-011-0119-5
Saedon NI, Tan MP, Frith J. The prevalence of orthostatic hypotension: A systematic review and meta-analysis. The Journal of Gerontology. 2020;75(1): 117-22. Available from: https://doi.org/10.1093/gerona/gly188
Moon J, Kim DY, Byun JI, Sunwoo JS, Lim JA, Kim T, et al. Orthostatic intolerance symptoms are associated with depression and diminished quality of life in patients with postural tachycardia syndrome. Health Qual Life Outcomes. 2016;14: 144. Available from: https://doi.org/
Cygankiewicz I, Zareba W. Heart rate variability. Handb Clin Neurol. 2013;117: 379-93. Available from: https://doi.org/10.1016/B978-0-444-53491-0.00031-6
Sato Y, Ichihashi K, Kikuchi Y, Shiraishi H, Momoi MY. Autonomic function in adolescents with orthostatic dysregulation measured by heart rate variability. Hypertens Res. 2007;30(7): 601-5. Available from: https://doi.org/10.1291/hypres.30.601
Swai J, Hu Z, Zhao X, Rugambwa T, Ming G. Heart rate and heart rate variability comparison between postural orthostatic tachycardia syndrome versus healthy participants; a systematic review and meta-analysis. BMC Cardiovasc Disord. 2019;19(1): 320. Published 2019 Dec 30. Available from: https://doi.org/10.1186/s12872-019-01298-y
Kovalchuk T, Boyarchuk O, Pavlyshyn H, Balatska N, Luchyshyn N. Analysis of heart rate variability in paediatric patients with vasovagal syncope. PediatriaPolska – Polish Journal of Paediatrics. 2019;94(6): 357-67. Available from: https://doi.org/10.5114/polp.2019.92965.
Wang Y, Zhang C, Chen S, et al. Heart rate variability predicts therapeutic response to Metoprolol in children with postural tachycardia syndrome. Front Neurosci. 2019;13: 1214. Available from: https://doi.org/10.3389/fnins.2019.01214
Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39(21): 1883-948. Available from: https://doi.org/10.1093/eurheartj/ehy037.
Tanaka H, Fujita Y, Takenaka Y, Kajiwara S, Masutani S, Ishizaki Y, et al. Japanese clinical guidelines for juvenile orthostatic dysregulation version 1. Pediatr Int. 2009;51(1): 169-79. Available from: https://doi.org/10.1111/j.1442-200X.2008.02783.x.
Lurbe E, Agabiti-Rosei E, Cruickshank JK, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016;34(10): 1887-920. Available from: https://doi.org/10.1097/HJH.0000000000001039
Berezhnyy VV, Romankevych IV. [Application of determination of heart rate variability in children]. Sovremennaya pediatriya. 2015;1: 87-91.Ukrainian.
Buchhorn J, Buchhorn R. The postural orthostatic stress syndrome in childhood: HRV analysis and the active standing test. Prev Med Commun Health. 2020;3: 1-7. Available from: https://doi.org/10.15761/PMCH.1000148
Kochy`na ML, Bila AA, Bondarenko IG, Bondarenko OV. [Features of changes in heart rate variability of students under the influence of mental and physical activity] Ukrainskyi zhurnal medytsyny, biolohii ta sportu. 2020;5,6(28): 396-403. Ukrainian. Available from: https://doi.org/10.26693/jmbs05.06.396
Shaffer F, Ginsberg J. An overview of heart rate variability metrics and norms. Front. Public Heal. 2017;5: 258. Available from: https://doi.org/10.3389/fpubh.2017.00258
Billman G. The LF/HF ratio does not accurately measure cardiac sympatho-vagal balance. Front. Physiol. 2013;4: 26. Available from: https://doi.org/10.3389/fphys.2013.00026
Goldstein D, Bentho O, Park M, Sharabi Y. LF power of heart rate variability is not a measure of cardiac sympathetic tone but may be a measure of modulation of cardiac autonomic outflows by baroreflexes. Exp Physiol. 2011;96: 1255-61. Available from: https://doi.org/ 10.1113/expphysiol.2010.056259
Stemper B, Bernardi L, Axelrod FB, Welsch G, Passino C, Hilz MJ. Sympathetic and parasympathetic baroreflex dysfunction in familial dysautonomia. Neurology. 2004;63(8): 1427-31. Available from: https://doi.org/10.1212/01.WNL.0000142034.92124.6A
Kazimierska A, Placek MM, Uryga A, Wachel P, Burzyńska M, Kasprowicz M. Assessment of Baroreflex sensitivity using time-frequency analysis during postural change and hypercapnia. Comput Math Methods Med. 2019;2019: 4875231. Available from: https://doi.org/10.1155/2019/4875231
Field ME, Donateo P, Bottoni N, Iori M, Brignole M, Kipp, et al. P-Wave Amplitude and PR changes in patients with inappropriate sinus tachycardia: Findings supportive of a central mechanism. J Am Heart Assoc. 2018;7(9): e008528. Available from: https://doi.org/10.1161/JAHA.118.008528
Vasheghani M, Sarvghadi F, Beyranvand MR, Emami H. The relationship between QT interval indices with cardiac autonomic neuropathy in diabetic patients: a case control study. Diabetol Metab Syndr. 2020;12: 102. Available from: https://doi.org/10.1186/s13098-020-00609-0
Kim JB, Hong S, Park JW, Cho DH, Park KJ, Kim BJ. Utility of Corrected QT Interval in Orthostatic Intolerance. PLoS ONE. 2014;9(9):e106417. Available from: https://doi.org/10.1371/journal.pone.0106417
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