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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (3): 414-421. doi: 10.19723/j.issn.1671-167X.2019.03.007

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Hemodynamic changes in standing-up test of children and adolescents with postural tachycardia syndrome

Chun-yan TAO1,Hong-xia LI1,Xue-ying LI2,Chao-shu TANG3,Hong-fang JIN1,Jun-bao DU1△()   

  1. 1. Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
    2. Department of Statistics, Peking University First Hospital, Beijing 100034, China
    3. Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Beijing 100191, China
    4. Key Laboratory of Molecular Cardiovascular Science, the Ministry of Education, Beijing 100191, China
  • Received:2019-03-12 Online:2019-06-18 Published:2019-06-26
  • Supported by:
    Supported by the fundamental Research Funds for the Central Universities: Peking University Clinical Scientist Program (BMU2019LCKXJ001)

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Abstract: Objective: To explore the hemodynamic changes in standing-up test of children and adolescents with postural tachycardia syndrome (POTS) and to compare hemodynamic parameters of POTS patients with decreased cardiac index (CI) and those with not-decreased CI.Methods: A retrospective study was conducted to show the trends of CI, total peripheral vascular resistance index (TPVRI), heart rate and blood pressure in standing-up test of 26 POTS patients and 12 healthy controls, and to compare them between the two groups. The POTS patients were divided into two groups based on CI decreasing or not in standing-up test, namely decreased CI group (14 cases) and not-decreased CI group (12 cases). The trends of the above mentioned hemodynamic parameters in standing-up test were observed and compared between decreased CI group and not-decreased CI group.Results: In standing-up test for all the POTS patients, CI (F=6.936, P=0.001) and systolic blood pressure (F=6.049, P<0.001) both decreased significantly, and heart rate increased obviously (F=113.926, P<0.001). However, TPVRI (F=2.031, P=0.138) and diastolic blood pressure (F=2.018, P=0.113) had no significant changes. For healthy controls, CI (F=3.646, P=0.016), heart rate (F=43.970, P<0.001), systolic blood pressure (F=4.043, P=0.020) and diastolic blood pressure (F=8.627, P<0.001) all increased significantly in standing-up test. TPVRI (F=1.688, P=0.190) did not change obviously. The changing trends of CI (F=6.221, P=0.001), heart rate (F=6.203, P<0.001) and systolic blood pressure (F=7.946, P<0.001) over time were significantly different between the patients and healthy controls, however, no difference was found in TPVRI and diastolic blood pressure (P > 0.05). Among the POTS patients, CI was significantly different between decreased CI group and not-decreased CI group (F=14.723, P<0.001). Systolic blood pressure of the former decreased obviously (F=8.010, P<0.001), but it did not change obviously in the latter (F=0.612, P=0.639). Furthermore, none of the changes of TPVRI, heart rate and diastolic blood pressure in standing-up test were significantly different between the two groups (P > 0.05). Age was an independent factor for decreased CI patients (P=0.013, OR=2.233; 95% CI, 1.183 to 4.216).Conclusion: POTS patients experience vital hemodynamic changes in standing-up test, part of them suffering from decreased CI, but others from not-decreased CI. Age is an independent factor for patients suffering from decreased CI.

Key words: Postural tachycardia syndrome, Cardiac index, Total peripheral vascular resistance index, Children, Adolescents

CLC Number: 

  • R725.4

Table 1

Comparison of baseline characteristics in POTS patients and control group"

Items POTS group (n=26) Control group (n=12) χ2 or t or Z value P value
Gender, male/female 11/15 6/6 0.197 0.658
Age/years 11.0±2.1 10.1±1.0 1.734 0.091
BMI/(kg/m2) 18.1±2.6 17.8±3.6 0.264 0.793
BSA/(m2) 1.30±0.20 1.18±0.20 1.513 0.139
Supine CI/[ L/(min·m2)] 2.13±0.71 1.79 (1.50, 3.03) -0.691 0.505
Supine TPVRI/[ mmHg·min/(L·m2)] 1.65 (0.50, 6.75) 1.98±0.60 -1.633 0.106
Supine HR/(/min) 74 (64, 100) 80±12 -0.881 0.379
Supine SBP/mmHg 109±13 105±11 0.903 0.372
Supine DBP/mmHg 63±10 61±7 0.670 0.507
ΔHR/(/min) 58±14 26±12 7.107 <0.001

Figure 1

Changes of hemodynamic parameters in standing-up test in POTS group and control group A, cardiac index; B, TPVRI: C, heart rate; D, systolic blood pressure; E, diastolic blood pressure. *P<0.05; data as x?±s; POTS, postural tachycardia syndrome; TPVRI, total peripheral vascular resistance index."

Figure 2

Examples of POTS patients with different cardiac index changing patterns in standing-up test A, cardiac index decreasing in standing-up test; B, cardiac index not-decreasing in standing-up test. POTS, postural tachycardia syndrome."

Table 2

Comparison of characteristics in POTS patients with decreased CI and those with not-decreased CI"

Items Decreased CI group (n=14) Not-decreased CI group (n=12) χ2 or t or Z value P value
Gender, male/female 4/10 7/5 2.345 0.126
Age/years 12.1±1.6 9.7±1.9 3.444 0.002
BMI/(kg/m2) 18.6±2.6 17.5±2.5 1.166 0.255
BSA/(m2) 1.39±0.21 1.20±0.25 2.153 0.042
Supine CI/[ L/(min·m2)] 2.57±0.62 1.62±0.41 4.531 < 0.001
Supine TPVRI/[ mmHg·min/(L·m2)] 1.18±0.59 2.08 (0.68, 6.75) -2.701 0.007
Supine HR/(/min) 77±9 69 (66, 93) -1.211 0.226
Supine SBP/mmHg 111±13 106±12 0.948 0.353
Supine DBP/mmHg 65±10 62±10 0.887 0.384
ΔHR/(/min) 59±15 58±13 0.182 0.857
Symptom scores 6 (2,20) 4±2 -2.050 0.040

Figure 3

Correlations between age and some other parameters in POTS patients A, body surface area; B, supine cardiac index; C, supine TPVRI; D, symptom scores. POTS, postural tachycardia syndrome; TPVRI, total peripheral vascular resistance index."

Table 3

Binary Logistic regression analysis of variables"

Variable B SE Wald OR (95% CI) P value
Age/years 0.803 0.324 6.144 2.233 (1.183 to 4.216) 0.013

Figure 4

Changes of hemodynamic parameters in standing-up test in POTS patients with decreased CI and those with not-decreased CI A, cardiac index; B, TPVRI; C, heart rate; D, systolic blood pressure; E, diastolic blood pressure. *P<0.05; data as x?±s; POTS, postural tachycardia syndrome; CI, cardiac index; TPVRI, total peripheral vascular resistance index."

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