Background Malignant vasovagal syncope(VVS)is a unique form of cardioinhibitory VVS,characterized by prolonged asystole.To deepen the understanding of this distinct type of VVS in children,this article reviews advance...Background Malignant vasovagal syncope(VVS)is a unique form of cardioinhibitory VVS,characterized by prolonged asystole.To deepen the understanding of this distinct type of VVS in children,this article reviews advancements in the potential pathogenesis,diagnostic approaches,clinical significance,and treatment controversies of malignant VVS in pediatric patients.Data sources This article was developed by reviewing the literature and studies in databases including PubMed and Chinese Journal Full-text Database up to September 2024.Search terms included“malignant vasovagal syncope”AND“children”or“vasovagal syncope”AND“asystole”AND“children”.Results To date,studies focused on malignant VVS in children remain limited.Theoretically,children with malignant VVS are at risk of physical or mental impairment due to this cardiac asystole,though no definite conclusions have been reached.The mechanism underlying the significant cardiac inhibition in malignant VVS remains unclear,and the treatment strategy of malignant VVS is debatable.Conclusions The understanding of children with malignant VVS is insufficient.Further research is required to evaluate the clinical features and the pathogenesis of pediatric VVS with cardiac asystole and to establish effective management strategies for malignant VVS.展开更多
Objective:Vitamin D is a group of fat-soluble molecules that are structurally similar to steroids.Emerging data have led to the hypothesis that Vitamin D plays a role in the regulation of many physiological processes ...Objective:Vitamin D is a group of fat-soluble molecules that are structurally similar to steroids.Emerging data have led to the hypothesis that Vitamin D plays a role in the regulation of many physiological processes beyond calcium and phosphorus homeostasis.With this review,we aimed to summarize the changes in Vitamin D levels in children with cardiovascular diseases based on the literature.In addition,we also reviewed the potential mechanisms underlying cardiovascular diseases associated with Vitamin D deficiency or insufficiency.Data Sources:The articles in English were searched from PubMed(1968-2016)and EMBASE(1991-2016),with the keywords of"Vitamin D AND cardiovascular diseases"and"Vitamin D AND children."Study Selection:Original articles and critical reviews about Vitamin D and cardiovascular risk in children were selected for review.Researches focused on adults were excluded.Results:Studies have shown that several pediatric cardiovascular diseases may be associated with Vitamin D deficiency or insufficiency,including hypertension,orthostatic intolerance,and Kawasaki disease.Conclusions:Vitamin D may play a role in the regulation of the cardiovascular system.Further investigation would hopefully disclose the usefulness of Vitamin D as a biomarker for cardiovascular diseases in children.展开更多
Background:Vasovagal syncope(VVS)is the most common cause of syncope in children.Neuropeptide Y(NPY)plays an important role in the regulation of blood pressure(BP),as well as myocardial contractility.This study aimed ...Background:Vasovagal syncope(VVS)is the most common cause of syncope in children.Neuropeptide Y(NPY)plays an important role in the regulation of blood pressure(BP),as well as myocardial contractility.This study aimed to explore the role of plasma NPY in VVS in children.Methods:Fifty-six children who were diagnosed with VVS(VVS group)using head-up tilt test(HUT)and 31 healthy children who were selected as controls(control group)were enrolled.Plasma NPY concentrations were detected.The independent t-test was used to compare the data of the VVS group with those of the control group.The changes in plasma NPY levels in the VVS group during the HUT,as well as hemodynamic parameters,such as heart rate(HR),BP,total peripheral vascular resistance(TPVR),and cardiac output(CO),were evaluated using the paired t-test.Furthermore,the correlations between plasma NPY levels and hemodynamic parameters were analyzed using bivariate correlation analysis.Results:The BP,HR,and plasma NPY(0.34±0.12 pg/ml vs.0.46±0.13 pg/ml)levels in the supine position were statistically low in the VVS group compared to levels in the control group(all P〈0.05).Plasma NPY levels were positively correlated with the HR(Pearson,R=0.395,P〈0.001)and diastolic BP(Pearson,R=0.311,P=0.003)when patients were in the supine position.When patients in the VVS group were in the supine position,elevated TPVR(4.6±3.7 mmHg·min^(-1)·L^(-1) vs.2.5±1.0 mmHg·min-1·L-1,respectively,P〈0.001;1 mmHg=0.133 kPa)and reduced CO(1.0±0.7 L/min vs.2.4±1.3 L/min,respectively,P〈0.001)were observed in the positive-response period compared with baseline values.The plasma NPY levels were positively correlated with TPVR(Spearman,R=0.294,P=0.028)but negatively correlated with CO in the positive-response period during HUT(Spearman,R=-0.318,P=0.017).Conclusions:Plasma NPY may contribute to the pathogenesis of VVS by increasing the TPVR and decreasing the CO during orthostatic regulation.展开更多
In children and adolescents,syncope is common and accounts for a considerable proportion of emergency visits.The underlying diseases of pediatric syncope mainly include neurally mediated syncope(NMS)and cardiogenic co...In children and adolescents,syncope is common and accounts for a considerable proportion of emergency visits.The underlying diseases of pediatric syncope mainly include neurally mediated syncope(NMS)and cardiogenic conditions.NMS accounts for 70–80%of pediatric syncopal cases,and one of the most common forms is vasovagal syncope(VVS)[1–3].In children with VVS,owing to the impairment of the barorefex integrity,the sympathetic system usually becomes overexcited after the change in position,leading to forceful contractions of a relatively empty ventricle and fnally causing a sympathetic withdrawal and an increased vagal activity.A relatively insufcient central volume,excessive vasodilation of peripheral vessel,autonomic nervous dysfunction,and neurohormonal disturbance may be aggravating factors.However,the efectiveness of previously unselected treatments for VVS has not been satisfactory.As such,a comprehensive assessment of the clinical characteristics,pathogenesis,and biochemical markers is needed to select the corresponding therapy.Since individualized treatment for VVS was proposed,several improvements have been made in the feld.展开更多
Vasovagal syncope(VVS)is the primary entity of neurally mediated syncope(NMS)in childhood,and its prognosis is usually considered benign.However,it is found in clini-cal practice that some children with VVS appear to ...Vasovagal syncope(VVS)is the primary entity of neurally mediated syncope(NMS)in childhood,and its prognosis is usually considered benign.However,it is found in clini-cal practice that some children with VVS appear to have a frequent recurrence of syncope and poor response to treat-ment[1],which might seriously affect their quality of life[2].In recent years,an increasing number of comorbidities of VVS have been reported.Liao et al.found that 31%of pediatric patients with NMS suffered from allergic disease[3],and Vallejo M reported that more than 50%of patients had headaches[4].These comorbidities might make the clinical manifestations even more complex.However,until now,it has been unclear whether comorbidities are associated with the prognosis of children and adolescents suffering from VVS.Therefore,the present study was conducted to examine whether there is any impact of comorbidities on the prognosis of pediatric VVS to better understand the outcome and management of children and adolescents with VVS.展开更多
基金National High-Level Hospital Clinical Research Funding(Multi-center Clinical Research Project of Peking University First Hospital)(2022CR59)Clinical Medicine Plus X—Young Scholars Project(PKU2022LCXQ028)the Fundamental Research Funds for the Central Universities,China.
文摘Background Malignant vasovagal syncope(VVS)is a unique form of cardioinhibitory VVS,characterized by prolonged asystole.To deepen the understanding of this distinct type of VVS in children,this article reviews advancements in the potential pathogenesis,diagnostic approaches,clinical significance,and treatment controversies of malignant VVS in pediatric patients.Data sources This article was developed by reviewing the literature and studies in databases including PubMed and Chinese Journal Full-text Database up to September 2024.Search terms included“malignant vasovagal syncope”AND“children”or“vasovagal syncope”AND“asystole”AND“children”.Results To date,studies focused on malignant VVS in children remain limited.Theoretically,children with malignant VVS are at risk of physical or mental impairment due to this cardiac asystole,though no definite conclusions have been reached.The mechanism underlying the significant cardiac inhibition in malignant VVS remains unclear,and the treatment strategy of malignant VVS is debatable.Conclusions The understanding of children with malignant VVS is insufficient.Further research is required to evaluate the clinical features and the pathogenesis of pediatric VVS with cardiac asystole and to establish effective management strategies for malignant VVS.
文摘Objective:Vitamin D is a group of fat-soluble molecules that are structurally similar to steroids.Emerging data have led to the hypothesis that Vitamin D plays a role in the regulation of many physiological processes beyond calcium and phosphorus homeostasis.With this review,we aimed to summarize the changes in Vitamin D levels in children with cardiovascular diseases based on the literature.In addition,we also reviewed the potential mechanisms underlying cardiovascular diseases associated with Vitamin D deficiency or insufficiency.Data Sources:The articles in English were searched from PubMed(1968-2016)and EMBASE(1991-2016),with the keywords of"Vitamin D AND cardiovascular diseases"and"Vitamin D AND children."Study Selection:Original articles and critical reviews about Vitamin D and cardiovascular risk in children were selected for review.Researches focused on adults were excluded.Results:Studies have shown that several pediatric cardiovascular diseases may be associated with Vitamin D deficiency or insufficiency,including hypertension,orthostatic intolerance,and Kawasaki disease.Conclusions:Vitamin D may play a role in the regulation of the cardiovascular system.Further investigation would hopefully disclose the usefulness of Vitamin D as a biomarker for cardiovascular diseases in children.
文摘Background:Vasovagal syncope(VVS)is the most common cause of syncope in children.Neuropeptide Y(NPY)plays an important role in the regulation of blood pressure(BP),as well as myocardial contractility.This study aimed to explore the role of plasma NPY in VVS in children.Methods:Fifty-six children who were diagnosed with VVS(VVS group)using head-up tilt test(HUT)and 31 healthy children who were selected as controls(control group)were enrolled.Plasma NPY concentrations were detected.The independent t-test was used to compare the data of the VVS group with those of the control group.The changes in plasma NPY levels in the VVS group during the HUT,as well as hemodynamic parameters,such as heart rate(HR),BP,total peripheral vascular resistance(TPVR),and cardiac output(CO),were evaluated using the paired t-test.Furthermore,the correlations between plasma NPY levels and hemodynamic parameters were analyzed using bivariate correlation analysis.Results:The BP,HR,and plasma NPY(0.34±0.12 pg/ml vs.0.46±0.13 pg/ml)levels in the supine position were statistically low in the VVS group compared to levels in the control group(all P〈0.05).Plasma NPY levels were positively correlated with the HR(Pearson,R=0.395,P〈0.001)and diastolic BP(Pearson,R=0.311,P=0.003)when patients were in the supine position.When patients in the VVS group were in the supine position,elevated TPVR(4.6±3.7 mmHg·min^(-1)·L^(-1) vs.2.5±1.0 mmHg·min-1·L-1,respectively,P〈0.001;1 mmHg=0.133 kPa)and reduced CO(1.0±0.7 L/min vs.2.4±1.3 L/min,respectively,P〈0.001)were observed in the positive-response period compared with baseline values.The plasma NPY levels were positively correlated with TPVR(Spearman,R=0.294,P=0.028)but negatively correlated with CO in the positive-response period during HUT(Spearman,R=-0.318,P=0.017).Conclusions:Plasma NPY may contribute to the pathogenesis of VVS by increasing the TPVR and decreasing the CO during orthostatic regulation.
基金Peking University Clinical Scientist Program(BJMU2019LCKXJ001)the Fundamental Research Funds for the Central Universities.
文摘In children and adolescents,syncope is common and accounts for a considerable proportion of emergency visits.The underlying diseases of pediatric syncope mainly include neurally mediated syncope(NMS)and cardiogenic conditions.NMS accounts for 70–80%of pediatric syncopal cases,and one of the most common forms is vasovagal syncope(VVS)[1–3].In children with VVS,owing to the impairment of the barorefex integrity,the sympathetic system usually becomes overexcited after the change in position,leading to forceful contractions of a relatively empty ventricle and fnally causing a sympathetic withdrawal and an increased vagal activity.A relatively insufcient central volume,excessive vasodilation of peripheral vessel,autonomic nervous dysfunction,and neurohormonal disturbance may be aggravating factors.However,the efectiveness of previously unselected treatments for VVS has not been satisfactory.As such,a comprehensive assessment of the clinical characteristics,pathogenesis,and biochemical markers is needed to select the corresponding therapy.Since individualized treatment for VVS was proposed,several improvements have been made in the feld.
基金supported by the Peking University Clinical Scientist Program(BMU2019LCKXJ001)the Fundamental Research Funds for the Central Universities,China.Clinical Medicine Plus X-Young Scholars Project(PKU2022LCXQ028)the Fundamental Research Funds for the Central Universities,China.Multi-center Study Project,Peking University First Hospital,China.
文摘Vasovagal syncope(VVS)is the primary entity of neurally mediated syncope(NMS)in childhood,and its prognosis is usually considered benign.However,it is found in clini-cal practice that some children with VVS appear to have a frequent recurrence of syncope and poor response to treat-ment[1],which might seriously affect their quality of life[2].In recent years,an increasing number of comorbidities of VVS have been reported.Liao et al.found that 31%of pediatric patients with NMS suffered from allergic disease[3],and Vallejo M reported that more than 50%of patients had headaches[4].These comorbidities might make the clinical manifestations even more complex.However,until now,it has been unclear whether comorbidities are associated with the prognosis of children and adolescents suffering from VVS.Therefore,the present study was conducted to examine whether there is any impact of comorbidities on the prognosis of pediatric VVS to better understand the outcome and management of children and adolescents with VVS.
