The Significance Of ECG Follow-up In Children With Positive Propranolol Test

Purpose: The ST-T changes of electrocardiograph with the symptoms of chest pain,chest tightness,palpitation and so on can be found in many diseases,such as myocarditis,cardiomyopathy,abnormal coronary artery origin,myocardical bridge,secondary coronary artery occlusion and beta receptor syndrome.Positive propranolol test is used of BRES diagnose.But it could also be found in some myocardial ischemic diseases,when their cardiac function is close to normal.Furthermore,the lack of clinical assessment on the significance and further therapeutic guidance of positive propranolol test in children is an urgent need for us to solve.The retrospective analysis of the data in children with positive propranolol test may be helpful for diagnosis of BRES by ECG follow-up,and reduce the misdiagnosis.Patients and Methods: In this study,total 68 children with positive propranolol test,21 children with negetive propranolol test and symptoms of chest pain,chest tightness,palpitation et al,diagnosed and treated in Pediatric Cardiovascular Department of Shengjing Hospital of China Medical University from February 2018 to January2023,were retrospectively analyzed.By following-up ECG and combining with their symptoms,examination results and treatment outcomes,the final diagnosis were analyzed.Results: Among of the 68 patients in this study,49(72.06%)cases were females.Age span was from 1.25 to 13 years.45 cases were BRES,18 cases were myocarditis,2cases were left ventricular non compaction(LVNC),2 cases with coronary aneurysm(CAA),1 case catecholamine-sensitive venticular tachycardia,1case abnormal coronary artery origin(AOVA),and 1 case coronary muscle bridge(MB).The most common symptom was chest tightness,fatigue and exhalation for 38 cases(55.88%).Total 7 cases with mild elevated hs-cTnI,9 cases elevated hs-cTnT,and 5 ones elevated NT-pro BNP.All the 68 cases performed ECHO,7 cases were abnormal:2CAA,2PE,2LVNC,1AOVA.After treatment of proparanolol orally,14 cases were un-improvement in ECG or symptoms among 30 cases,while in 38 cases untreatment group,7cases were un-improvement,all the un-improve cases who were over 6 years old taken the movement ECG,1 case was CPVT.CTCA were performed in 14 cases,who have positive propranolol test and movement ECG or was indicated abnormal coronary artery by cardiac ultrasound,as a result:1 case MB,1 case CAA and 1 case AOVA were found.CMR were performed in 14 cases of those with negative CTCA or highly suspected myocarditis or cardiomyopathy,thus,4 cases myocarditis,1 case of pericardial effusion,1 case of LVNC were found.Suspected myocarditis but unable to perform CMR for too young,ECT was performed in 5 cases and 1 showed myocardial ischemia.Conclusion:Propranolol test is limited,it can be considered as BRES when they have the symptoms of chest tightness,palpitation,et al,continued abnormal ST-T changes of ECG over four days,normal myocardial bio maker and ECHO.But follow-up of ECG was needed,positive one perform CTCA,and perform CMR if CTCA was negative.The further examination(such as CTCA,movement test,CMR and ECT)should be performed when the patient was suspected as myocarditis,cardiomyopathy and abnormal coronary artery,with infection or symptoms appearing after fatigue.More women than men have BRES among children.