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Twenty-four-hour urine NE level as a predictor of the therapeutic response to metoprolol in children with recurrent vasovagal syncope

  • Qingyu Kong
  • Xiaofei Yang
  • Zhifeng Cai
  • Yanyan Pan
  • Minmin Wang
  • Mengmeng Liu
  • Cuifen ZhaoEmail author
Original Article
  • 15 Downloads

Abstract

Background

Vasovagal syncope (VVS) is a heterogeneous disorder that creates challenges for treatment. Metoprolol is an important therapeutic option for children with VVS.

Aims

The study examined the predictive value of 24-h urine norepinephrine (NE) levels in the assessment of the therapeutic efficacy of metoprolol for recurrent VVS in children.

Methods

Thirty-eight children with recurrent VVS and 20 healthy children were enrolled in our study. Twenty-four-hour urine NE levels were measured by LC-MS-MS. VVS children were diagnosed by BHUTT and/or SNHUTT, and received metoprolol treatment for 3 months. Symptom scoring was utilized to evaluate the therapeutic effect. A ROC curve was used to investigate the predictive value of 24-h urine norepinephrine levels.

Results

There exists significant correlation between 24-h urine NE levels and supine systolic and diastolic blood pressures. The 24-h urine NE levels of responders (40.75 ± 12.86 μg/24 h) were higher than those of nonresponders (21.48 ± 6.49 μg/24 h), and there was a significant difference between the two groups (P < 0.001). A ROC curve of the predictive value of 24 h urine NE levels revealed that the area under the curve was 0.926. A cutoff value for 24-h urine NE level of 34.84 μg/24 h produced both high sensitivity (70%) and specificity (100%) in predicting the efficacy of metoprolol therapy for VVS.

Conclusions

Patients with high 24-h urine NE levels have higher supine systolic and diastolic pressures and more effective responses to metoprolol. A 24-h urine norepinephrine level of > 34.84 μg/24 h was an indicator of the effectiveness of metoprolol therapy for VVS in children.

Keywords

Children Metoprolol Norepinephrine Recurrent vasovagal syncope Urine 

Abbreviations

NE

norepinephrine

VVS

vasovagal syncope

LC-MS-MS

liquid chromatography-tandem mass spectrometry

BHUTT

baseline head-up tilt test

SNHUTT

sublingual nitroglycerin-provocative head-up tilt test

ROC

receiver-operating characteristic

HR

heart rate

BP

blood pressure

SBP

systolic blood pressure

DBP

diastolic blood pressure

OI

orthostatic intolerance

AUC

area under the curve

CI

confidence interval

ORS

oral rehydration salts

Notes

Acknowledgements

We thank the Beijing Harmony Health Medical Diagnostics Co., Ltd., for contributing to these studies.

Authors’ contributions

QYK: data acquisition and analysis, writing. ZFC, MMW: performed the experiments. YYP, MML: data acquisition. CFZ: review and editing. All authors read and approved the final manuscript.

Funding

This study was supported in part by grants from the National Natural Science Foundation of China (No. 30900730) and Technology Development Plan of Shandong Province (2014GSF118066). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Consent for publication

Not applicable.

Ethics approval and consent to participate

This study was approved by the ethics committee of Qilu Hospital of Shandong University, and all participants’ guardians were fully informed of the purpose and methods of the study.

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Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  1. 1.Department of Pediatrics, Qilu HospitalShandong UniversityJinanChina
  2. 2.Department of PediatricsYidu central hospital of WeifangWeifangChina
  3. 3.Department of PediatricsQilu Children’s Hospital of Shandong UniversityJinanChina

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