直立倾斜试验不同时间点心率及差值在成人体位性心动过速综合征诊断的比较

Comparison of heart rate and heart rate difference at different time points of head-up tilt test for the diagnosis of postural tachycardia syndrome in adults

目的 探讨在直立倾斜试验(HUTT)不同时间点的心率及其与基础心率的差值对体位性心动过速综合征(POTS)的诊断效率。方法 回顾2022年10月至2023年3月在北京大学人民医院进行直立倾斜试验的连续228例中完成20分钟基础倾斜的188例成年患者的心电监测,分析比较POTS患者及阴性患者在基础倾斜第5分钟/10分钟/15分钟/20分钟各时间点的心率(HR)及其与倾斜前平卧位基础心率的差值(HRD)变化的特点。结果 (1)188例(男78例)患者中,血管迷走性反应、直立性低血压及POTS均为阴性者54例(男22例),第5分钟检出POTS者9例(男4例),第10分钟检出POTS者16例(男6例),第15分钟检出POTS者18例(男7例),这3个时间点任一点检出POTS者为总POTS组共29例(男11例);(2)总POTS组与阴性组相比,平卧时基础HR无差异;倾斜第5分钟、10分钟、15分钟及20分钟时POTS组HR和HRD显著高,P值均<0.001;(3)各组内比较,倾斜位各时间点HR均高于平卧时,P值均<0.001;除第5分钟检出POTS组外,各组第10分钟比第5分钟的HR高,P值≤0.001;第10分钟较第15分钟以及第15分钟较第20分钟无显著差异;(4)用于预测POTS阳性时,HRD5、HRD10、HRD15及这3个时间点HRD联合指标的ROC曲线下面积均>0.9而具有较高准确性并以3个时间点HRD联合指标的ROC曲线下面积最大(0.987);(5)总POTS组的年龄显著低于阴性组,两组性别比例无显著差异均以女性多见,总POTS组的体重指数显著低于阴性组。结论 POTS患者在HUTT 20分钟内的心率增加都很显著,前10分钟内心率随着时间的延长而增加明显,引入第15分钟时心率值及差值后,可以提高POTS检出率。

Objective To investigate the diagnostic efficiency of heart rate and heart rate difference at different time points of head-up tilt test(HUTT)on postural tachycardia syndrome(POTS)in adults.Methods The ECG monitoring of 188 adult patients who completed 20 min basal tilt was reviewed among 228 consecutive patients who underwent HUTT in Peking University People's Hospital from October 2022 to March 2023,and the characteristics of heart rate(HR)and the heart rate difference(HRD)change from the supine position before tilt were compared between POTS patients and negative patients at each time point of 5th/1Oth/15th/20th minute during basal tilt.Results Among the 188 patients,54 cases(22 males)were negative for vasovagal response,orthostatic hypotension and POTS,9 cases(4 males)of POTS were detected at 5th minute,16 cases(6 males)of POTS were detected at 10th minute,18 cases(7 males)of POTS were detected at 15th minute,and a total of 29 cases(11 males)were detected at any of these three time points.Compared with the negative group,there was no diference in the basal HR in the supine position in the total POTS group;At the 5th,10th,15th and 20th minute of the til,the HR and HRD of the total POTS group were significantly higher,and the P value was<0.001.In the comparison within each group,the HR at each time point during tilt was higher than that in the supine position,and the P value was<0.001;except for the POTS group detected at the 5th minute,the HR of each group was higher at the 1Oth minute than at the 5th minute,and the P value was≤0.001;there were no significant differences between the 10th minute and the 15th minute and the 15th minute and the 20th minute.①When used to predict POTS positive,the area under the ROC curve of HRD5,HRD10,HRD15 and these three time points HRD combined index is greater than 0.9,and the above indicators have high accuracy,and the area under the ROC curve of the three time points HRD combined index is the largest(0.987).The age of the total POTS group was significantly lower than that of the negative group,and there was no significant difference in the gender ratio between the two groups,both were more common in female,and the body mass index of the total POTS group was significantly lower than that of the negative group.Conclusions The heart rate of patients with POTS increased significantly within the first 20 minutes of HUTT,and the heart rate increased significantly with the extension of time in the first 10 minutes,and the comparison of HR and HRD in the first 15 minutes of HUTT can improve the detection rate of POTS.