Plasma Hydrogen Sulfide in Differential Diagnosis between Vasovagal Syncope and Postural Orthostatic Tachycardia Syndrome in Children

Objective To explore the predictive value of plasma hydrogen sulfide (H(2)S) in differentiating between vasovagal syncope (VVS) and postural orthostatic tachycardia syndrome (POTS) in children. Study design Patients were divided between the POTS group (n = 60) and VVS group (n = 17) by using either the head-up test or head-up tilt test. Twenty-eight healthy children were selected for the control group. Plasma concentrations of H(2)S were determined for children in all groups (POTS, VVS, and control). Results Plasma levels of H(2)S were significantly higher in children with VVS (95.3 +/- 3.8 mu mol/L) and POTS (100.9 +/- 2.1 mu mol/L) than in children in the control group (82.6 +/- 6.5 mu mol/L). Compared with the VVS group, the POTS group had plasma levels of H(2)S that were significantly increased. The receiver operating characteristic curve for the predictive value of H(2)S differentiation of VVS from POTS showed a H(2)S plasma level of 98 mu mol/L as the cutoff value for high probability of distinction. Such a level produced both high sensitivity (90%) and specificity (80%) rates of correctly discriminating between patients with VVS and patients with POTS. Conclusion H(2)S plasma level has both high sensitivity and specificity rates to predict the probability of correctly differentiating between patients with VVS and patients with POTS. (J Pediatr 2012;160:227-31).PediatricsSCI(E)PubMed11ARTICLE2227-23116