Multivariate predictive model of the therapeutic effects of metoprolol in paediatric vasovagal syncope: a multi-centre study

作者：Yaxi Cui, Jing Zhang, Yuwen Wang, Ying Liao, Keyu Liu, Wenrui Xu, Shu Wu, Chufan Sun, Chunyu Zhang, Qingyou Zhang, Ping Liu, Yuli Wang, Yanjun Deng, Chen Shen, Yao Lin, Cai Hong, Juan Zhang, Runmei Zou, Ping Liu, Shuo Wang, Hongfang Jin, Lin Shi, Cheng Wang, Junbao Du · 发表于：EBioMedicine · 年份：2025 · DOI：10.1016/j.ebiom.2025.105595 · 被引用次数：12 · 研究领域：Cardiovascular Syncope and Autonomic Disorders、Pathogenesis and Treatment of Hiccups、Heart Rate Variability and Autonomic Control

BACKGROUND: Metoprolol therapy for paediatric vasovagal syncope (VVS) has yielded inconsistent results, necessitating predictive markers. We aimed to develop and validate models to identify paediatric VVS patients likely to benefit from metoprolol. METHODS: 478 metoprolol-treated paediatric patients with VVS were enrolled from three syncope units and divided into retrospective training (March 2017-March 2023, n = 323) and prospective validation cohorts (April 2023-March 2024, n = 155). Fourteen patients (2.9%) were excluded for lacking follow-up data. Patients were classified as responders or non-responders based on symptom improvement after 1-3 months of metoprolol therapy. Univariate analysis and logistic regression were used to select the candidate predictors. A nomogram and a scoring model were established to predict treatment efficacy. The model values were analysed using a receiver operating characteristic (ROC) curve. Consistency was evaluated using the Hosmer-Lemeshow (H-L) test, calibration curve, and concordance index (C-index). The clinical utility of model was assessed through the decision curve analysis (DCA). Internal validation was performed using the bootstrap approach. The predictive model derived from the training cohort was validated in the validation cohort to assess its accuracy and feasibility. FINDINGS: Increased heart rate during positive response in head-up tilt test (ΔHR), corrected QT interval dispersion (QTcd), and standard deviation of all normal-...