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Significance of red cell distribution width in the differential diagnosis between neurally mediated syncope and arrhythmic syncope in children

Published online by Cambridge University Press:  19 July 2016

Qingyou Zhang ,
Yaqi Li ,
Ying Liao  and
Junbao Du
Qingyou Zhang
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China
Yaqi Li
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China
Ying Liao
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China
Junbao Du*
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China
*
Correspondence to: Professor J. Du, Department of Pediatrics, Peking University First Hospital, Xi-An Men Street No. 1, West District, Beijing 100034, China. Tel: +8610 8357 3165; Fax: +8610 6653 0532; E-mail: junbaodu1@126.com
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Abstract

Objectives

The aim of the present study was to explore the predictive value of red cell distribution width as a means to differentiate between neurally mediated syncope and arrhythmic syncope in children.

Method

Patients were divided into a neurally mediated syncope group (n=72) and an arrhythmic syncope group (n=21) on the basis of clinical history, results of the head-up tilt test, electrocardiography, and 24-hour ambulatory electrocardiography. As controls, we recruited 55 healthy children. Red cell distribution width was determined for children in all groups. A receiver operating characteristic curve was drawn to study the predictive effect of red cell distribution width to differentiate between neurally mediated syncope and arrhythmic syncope.

Results

Red cell distribution width was significantly higher in children with neurally mediated syncope than in children with arrhythmic syncope and the control group. A receiver operating characteristic curve on the predictive value of red cell distribution width in differentiating neurally mediated syncope from arrhythmic syncope showed that the area under the curve was 0.841 (95% confidence interval: 0.737–0.945, p<0.05). A red cell distribution width value of 12.8% as the cut-off value yielded a sensitivity of 80.6% and a specificity of 76.2% in discriminating between patients with neurally mediated syncope and arrhythmic syncope.

Conclusion

Red cell distribution width value of ⩾12.8% might be a useful adjunct for primary-care physicians to differentiate neurally mediated syncope from arrhythmic syncope in children.

Keywords

Red cell distribution widthsyncopearrhythmic syncopechildren
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 4 , May 2017 , pp. 691 - 696
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Copyright
© Cambridge University Press 2016 

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Footnotes

*

They contributed equally to this work.

References

1. European Heart Rhythm Association (EHRA); Heart Failure Association (HFA); Heart Rhythm Society (HRS) et al. Guidelines for the diagnosis and management of syncope (version 2009): the task force for the diagnosis and management of syncope of the European Society of Cardiology (ESC). Eur Heart J 2009; 30: 2631–2671.Google Scholar
2. Friedman, KG, Alexander, ME. Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease. J Pediatr 2013; 163: 896–901.Google Scholar
3. Bo, I, Carano, N, Agnetti, A, et al. Syncope in children and adolescents: a two-year experience at the department of paediatrics in Parma. Acta Biomed 2009; 80: 36–41.Google ScholarPubMed
4. Massin, MM, Bourguignont, A, Coremans, C, Comté, L, Lepage, P, Gérard, P. Syncope in pediatric patients presenting to an emergency department. J Pediatr 2004; 145: 223–228.Google Scholar
5. McLeod, KA. Dysautonomia and neurocardiogenic syncope. Curr Opin Cardiol 2001; 16: 92–96.Google Scholar
6. Zhang, Q, Zhu, L, Wang, C, et al. Value of history taking in children and adolescents with cardiac syncope. Cardiol Young 2013; 23: 54–60.Google Scholar
7. Tretter, T, Kavey, RE. Distinguishing cardiac syncope from vasovagal syncope in a referral population. J Pediatr 2013; 163: 1618–1623.Google Scholar
8. Jarjour, IT, Jarjour, LK. Low iron storage and mild anemia in postural tachycardia syndrome in adolescents. Clin Auton Res 2013; 23: 175–179.Google Scholar
9. Öner, T, Guven, B, Tavli, V, Mese, T, Yilmazer, MM, Demirpence, S. Postural orthostatic tachycardia syndrome (POTS) and vitamin B12 deficiency in adolescents. Pediatrics 2014; 133: 138–142.Google Scholar
10. Winkler, AS, Blair, D, Marsden, JT, Peters, TJ, Wessely, S, Cleare, AJ. Autonomic function and serum erythropoietin levels in chronic fatigue syndrome. J Psychosom Res 2004; 56: 179–183.Google Scholar
11. Stewart, JM. Reduced iron stores and its effect on vasovagal syncope simple faint. J Pediatr 2008; 153: 9–11.Google Scholar
12. Daoud, AS, Batieha, A, al-Sheyyab, M, Abuekteish, F, Hijazi, S. Effectiveness of iron therapy on breath-holding spells. J Pediatr 1997; 130: 547–550.Google Scholar
13. Ganjehei, L, Massumi, A, Razavi, M, Wilson, JM. Orthostatic hypotension as a manifestation of vitamin B12 deficiency. Tex Heart Inst J 2012; 39: 722–723.Google Scholar
14. Salvagno, GL, Sanchis-Gomar, F, Picanza, A, Lippi, G. Red blood cell distribution width: a simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci 2014; 52: 86–105.Google Scholar
15. Schwartz, PJ, Ackerman, MJ. The long QT syndrome: a transatlantic clinical approach to diagnosis and therapy. Eur Heart J 2013; 34: 3109–3116.CrossRefGoogle Scholar
16. Schwartz, PJ. Practical issues in the management of the long QT syndrome: focus on diagnosis and therapy. Swiss Med Wkly 2013; 143: w13843.Google Scholar
17. Semelka, M, Gera, J, Usman, S. Sick sinus syndrome: a review. Am Fam Physician 2013; 87: 691–696.Google Scholar
18. Roston, TM, Vinocur, JM, Maginot, KR, et al. Catecholaminergic polymorphic ventricular tachycardia in children: an analysis of therapeutic strategies and outcomes from an international multicenter registry. Circ Arrhythm Electrophysiol 2015; 8: 633–642.Google Scholar
19. Grubb, BP, Temesy-Armos, P, Moore, J, et al. The use of head-upright tilt table testing in the evaluation and management of syncope in children and adolescents. Pacing Clin Electrophysiol 1992; 15: 742–748.Google Scholar
20. Strieper, MJ, Auld, DO, Hulse, JE, et al. Evaluation of recurrent pediatric syncope: role of tilt table testing. Pediatrics 1994; 93: 660–662.Google Scholar
21. Zhao, J, Han, Z, Zhang, X, et al. A cross-sectional study on upright heart rate and BP changing characteristics: basic data for establishing diagnosis of postural orthostatic tachycardia syndrome and orthostatic hypertension. BMJ Open 2015; 5: e007356.Google Scholar
22. Zhang, Q, Du, J, Wang, C, et al. The diagnostic protocol in children and adolescents with syncope: a multi-centre prospective study. Acta Paediatr 2009; 98: 879–884.Google Scholar
23. Swets, JA. Measuring the accuracy of diagnostic systems. Science 1988; 240: 1285–1293.Google Scholar
24. Zhang, Q, Jin, H, Qi, J, Yan, H, Du, J. Diagnostic value of serum brain natriuretic peptide in syncope in children and adolescents. Acta Paediatr 2013; 102: e210–e214.Google Scholar
25. Sazawal, S, Dhingra, U, Dhingra, P, et al. Efficiency of red cell distribution width in identification of children aged 1-3 years with iron deficiency anemia against traditional hematological markers. BMC Pediatr 2014; 14: 8.Google Scholar