title: Orthostatic plasma norepinephrine level as a predictor for therapeutic response to metoprolol in children with postural tachycardia syndrome.
abstract: BACKGROUND
  Postural tachycardia syndrome (POTS) is a heterogeneous disorder that creates challenges for treatment. Beta-blocker was one of the most commonly used drugs, but it is inconsistently effective. The purpose of this study is to explore whether orthostatic plasma norepinephrine level could be an indicator of therapeutic effectiveness of metoprolol for POTS in children.
  
  
  METHODS
  Twenty-seven children with POTS were enrolled in our study. They received metoprolol treatment, and their orthostatic plasma norepinephrine levels were measured by high-performance liquid chromatography method. Three months after rmetoprolol treatment, 25 patients were followed up. A receiver-operating characteristic (ROC) curve was used to explore the predictive value of orthostatic plasma norepinephrine level.
  
  
  RESULTS
  The symptom severity and increment of heat rate from supine position to upright of patients positively correlated with their orthostatic plasma norepinephrine level (r=0.599, P<0.001; r=0.633, P<0.001, respectively). Orthostatic plasma norepinephrine level in responders to metoprolol was significantly higher than that of nonresponders (P=0.028). A ROC curve on the predictive value of orthostatic plasma norepinephrine level showed that the area under the curve was 0.785. Using a cutoff value for orthostatic plasma norepinephrine level of 3.59 pg/ml yielded both sensitivity (76.9%) and specificity (91.7%) in predicting the efficacy of metoprolol therapy for POTS.
  
  
  CONCLUSIONS
  Orthostatic plasma norepinephrine level of>3.59 pg/ml was an indicator of the effectiveness of metoprolol therapy for POTS in children and adolescents.
authors.forename: Qingyou
authors.initials: Q
authors.lastname: Zhang
authors.forename: Xia
authors.initials: X
authors.lastname: Chen
authors.forename: Jiawei
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Pediatrics, Peking University First Hospital, Xi-An Men Street No, 1, West District, Beijing 100034, PR China. junbaodu1@126.com.
authors.forename: Junbao
authors.initials: J
authors.lastname: Du
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D009638:Norepinephrine / Q000097:blood*; D054972:Postural Orthostatic Tachycardia Syndrome / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology; D011379:Prognosis; D012372:ROC Curve; D016896:Treatment Outcome
chemical_list: D008790:Metoprolol; D009638:Norepinephrine