AUTHOR=Yuan Piaoliu , Lian Zhouhui , Wang Yuanyuan , Zhang Chunyu , Jin Hongfang , Du Junbao , Huang Yaqian , Liao Ying 

TITLE=Poincaré plot can help predict the curative effect of metoprolol for pediatric postural orthostatic tachycardia syndrome

JOURNAL=Frontiers in Neuroscience

VOLUME=Volume 17 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2023.1280172

DOI=10.3389/fnins.2023.1280172

ISSN=1662-453X

ABSTRACT=Purpose: To study whether a Poincaré plot can help predict the curative effect of metoprolol for postural orthostatic tachycardia syndrome (POTS) in children.: Pediatric patients with POTS who were administered metoprolol were retrospectively included. The collected data included general data (sex, age, height, weight, and body mass index), the condition and treatment (baseline orthostatic intolerance symptom score and course of metoprolol treatment), vital signs (supine heart rate [HR], supine blood pressure, and increased HR during standing test), HR variability indices (standard deviation of normal-to-normal intervals [SDNN]; standard deviation of the averages of normal-to-normal intervals [SDANN]; mean standard deviation of the NN intervals for each 5-min segment [SDNNI]; root mean square of the successive differences [rMSSD]; percentage of adjacent NN intervals that differ by > 50 ms [pNN50]; triangular index; ultra-low [ULF], very low [VLF], low [LF], and high frequency [HF]; total power [TP]; and LF/HF ratio), and graphical parameters of the Poincaré plot (longitudinal axis [L], transverse axis [T], and L/T).Receiver operator characteristic curves were used to calculate the predictive function of the indices with significant differences between patients who responded and those who did not. The index combination with the highest predictive value was obtained through series-parallel analysis.Results: Overall, 40 responders and 23 non-responders were included. The L and T in the Poincaré plots and rMSSD, pNN50, HF, and TP of the HR variability data were significantly lower in participants who responded to metoprolol than in participants who did not (P < 0.001). The L/T of participants who responded to metoprolol was greater than that of participants who did not (P < 0.001). Moreover, we noted a strong correlation between every two indices among L, T, rMSSD, pNN50, HF, TP, and L/T (P < 0.05). T < 573.9 ms combined with L/T > 2.9 had the highest performance for predicting the effectiveness of using metoprolol, with a sensitivity of 85.0%, specificity of 82.6%, and accuracy of 84.1%.In the Poincaré plot, a T < 573.9 ms combined with an L/T > 2.9 is helpful in predicting good outcomes of using metoprolol to treat pediatric POTS.