Twenty-four-hour urine NE level as a predictor of the therapeutic response to metoprolol in children with recurrent vasovagal syncope
Vasovagal syncope (VVS) is a heterogeneous disorder that creates challenges for treatment. Metoprolol is an important therapeutic option for children with VVS.
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.
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.
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.
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.
KeywordsChildren Metoprolol Norepinephrine Recurrent vasovagal syncope Urine
liquid chromatography-tandem mass spectrometry
baseline head-up tilt test
sublingual nitroglycerin-provocative head-up tilt test
systolic blood pressure
diastolic blood pressure
area under the curve
oral rehydration salts
We thank the Beijing Harmony Health Medical Diagnostics Co., Ltd., for contributing to these studies.
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.
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
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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