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Arterial Baroreceptor Physiology: Differences Between Normal Subjects and Pediatric Patients with Postural Tachycardia and Neurocardiogenic Syncope

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Abstract

The arterial baroreceptor reflex in children and adolescents has not been well studied in the current literature with a lack of agreed upon normal values, particularly in postural orthostatic tachycardia syndrome (POTS) or neurocardiogenic syncope (NCS). We used the sequence method and head-up tilt test (HUTT) to evaluate baroreceptor function in 3 phases: baseline supine position for 10 min, head-up position at 70° for 30 min or until syncope, and post-tilt supine reposition for 10 min. We measured the number of baroreceptor events, baroreceptor effectiveness index (BEI), and the magnitude of sensitivity of the events at each phase of HUTT. We studied 198 individuals (49 normal subjects, 67 POTS, 82 NCS) with age ranges from 8 to 21 years. The data show a statistically significant decrease in slope and BEI in patients with POTS and NCS during the head-up phase, with an increase in activity in the lag 1 and 2 portions of all phases in patients with POTS. This study provides terminology to describe baroreceptor function and identifies the slope and BEI portions of the baroreceptor reflex as the most useful objective measures to differentiate pediatric patients with POTS and NCS from normal subjects.

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Abbreviations

HUTT:

Head-up tilt test

POTS:

Postural orthostatic tachycardia syndrome

NCS:

Neurocardiogenic syncope

BRR:

Baroreceptor reflex response

BEI:

Baroreceptor effectiveness index

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Authors and Affiliations

  1. Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St. MSB 3.156, Houston, TX, 77030, USA

    Mohammad S. Alnoor

  2. Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA

    Holly K. Varner

  3. Division of Child and Adolescent Neurology, Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA

    Ian J. Butler & Jeremy E. Lankford

  4. Division of Clinical and Translational Research, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA

    Liang Zhu

  5. Division of Pediatric Cardiology, Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA

    Mohammed T. Numan

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  1. Mohammad S. Alnoor
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Correspondence to Mohammad S. Alnoor.

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Alnoor, M.S., Varner, H.K., Butler, I.J. et al. Arterial Baroreceptor Physiology: Differences Between Normal Subjects and Pediatric Patients with Postural Tachycardia and Neurocardiogenic Syncope. Pediatr Cardiol 43, 1011–1019 (2022). https://doi.org/10.1007/s00246-022-02815-1

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