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. 2020 Jul;25(4):e12747.
doi: 10.1111/anec.12747. Epub 2020 Feb 29.

Diagnostic and prognostic value of T-wave amplitude difference between supine and orthostatic electrocardiogram in children and adolescents with postural orthostatic tachycardia syndrome

Yuwen Wang  1   2 , Yi Xu  1   2 , Fang Li  1   2 , Ping Lin  1   2 , Juan Zhang  1   2 , Runmei Zou  1   2 , Cheng Wang  1   2
Affiliations

Diagnostic and prognostic value of T-wave amplitude difference between supine and orthostatic electrocardiogram in children and adolescents with postural orthostatic tachycardia syndrome

Yuwen Wang et al. Ann Noninvasive Electrocardiol. 2020 Jul.

Abstract

Objective: To investigate the diagnostic and prognostic value of T-wave amplitude difference between supine and orthostatic electrocardiogram (ECG) in children and adolescents with postural orthostatic tachycardia syndrome (POTS).

Methods: A total of 100 children and adolescents (POTS group, 50 males and 50 females, aged at 11.0 ± 2.4 years) diagnosed as POTS were enrolled from August 2013 to July 2016. Seventy-one children were matched as the control group according to age and sex. All cases completed the supine and orthostatic ECG.

Results: (a) Compared with the control group, the T-wave amplitude difference in leads I, II, aVL, V4 , V5, and V6 and the heart rate (HR) difference increased in POTS group. (b) Logistic regression analysis: The T-wave amplitude difference in leads V4 , V5 , and V6 and HR difference have statistical significance for POTS diagnosis. (c) Diagnostic test evaluation: When HR difference was ≥ 15 times/min, T-wave amplitude difference in lead V5 was ≥0.15 mV, T-wave amplitude difference in leads V4 and V6 were ≥0.10 mV, and the sensitivity and specificity of POTS diagnosis were 35.0% and 88.7%. (d) Follow-up: There was no significant difference in HR difference and T-wave amplitude difference in the nonresponse groups. In the response group, the T-wave amplitude difference in lead V4 was reduced than the initial value.

Conclusions: The HR difference and T-wave amplitude difference in leads V4, V5, and V6 between supine and orthostatic ECG are of help in assisting the diagnosis of POTS but no obviously significance on prognosis estimation of it.

Keywords: adolescents; children; electrocardiography; orthostatic position; postural orthostatic tachycardia syndrome; supine position.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
The comparison of HR and T‐wave amplitude in 12 leads between supine and orthostatic electrocardiogram (ECG). (a) The HR in the supine and orthostatic ECG of the control group. (b) The T‐wave amplitude in the supine and orthostatic ECG of the control group. (c) The HR in the supine and orthostatic ECG of POTS group. (d) The T‐wave amplitude in the supine and orthostatic ECG of POTS group. (e) The difference of HR in the supine and orthostatic ECG between POTS group and control group. (f) The difference of T‐wave amplitude in the supine and orthostatic ECG between POTS group and control group. * p < .05, ** p < .01
Figure 2
Figure 2
The receiver operating characteristic (ROC) curve of predictive value on POTS diagnosis between the supine and orthostatic electrocardiogram (ECG) index. (a) The ROC curve of the HR difference on POTS diagnosis. (b) The ROC curve of the T‐wave amplitude difference in lead V4 on POTS diagnosis. (c) The ROC curve of the T‐wave amplitude difference in lead V5 on POTS diagnosis. (d) The ROC curve of the T‐wave amplitude difference in lead V6 on POTS diagnosis. The y‐axis represents sensitivity, and the x‐axis represents the false‐positive rate (1‐specificity). The 45° straight line stands for the reference line indicating the sensitivity, and the false‐positive rate is equal
Figure 3
Figure 3
Cumulative response rate of POTS patients receiving treatment during follow‐up
Figure 4
Figure 4
The reexamined HR difference and T‐wave amplitude difference on supine and orthostatic electrocardiogram compared with those of the initial diagnosis. (a) The reexamined and the initial HR difference in the nonresponsive group. (b) The reexamined and the initial T‐wave amplitude difference in the nonresponsive group. (c) The reexamined and the initial HR difference in the responsive group. (d) The reexamined and the initial T‐wave amplitude difference in the responsive group. * p < .05
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