{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T12:35:00Z","timestamp":1772195700823,"version":"3.50.1"},"reference-count":40,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: To investigate the changes in T-wave amplitude and Tp-Te interval on supine and standing electrocardiograms (ECGs) in pediatric postural orthostatic tachycardia syndrome (POTS), and to explore their predictive value for the therapeutic effect of metoprolol. Methods: A total of 59 children diagnosed with POTS who presented with syncope or pre-syncopal symptoms were enrolled as the POTS group, and 52 healthy children served as the control group. Supine and standing ECGs were recorded for all subjects, and T-wave amplitude and Tp-Te interval were measured. Children with POTS were followed-up after metoprolol treatment and divided into a therapeutic response group and a non-response group. Results: (1) Comparison of supine vs. standing ECGs: In the POTS group, standing posture (compared with supine posture) was associated with increased heart rate (HR), decreased T-wave amplitude in leads II, III, aVF, V4, V5, and V6, shortened Tp-Te interval in leads I, II, III, aVR, aVF, V1, V3, V4, V5, and V6, and elevated Tp-Te\/QT ratio in leads aVL and V5 (all p &lt; 0.05). (2) Comparison with the control group: The POTS group exhibited a greater HR difference (\u0394HR), as well as larger differences in T-wave amplitude (\u0394T-wave amplitude) between supine and standing positions in leads II, aVR, aVL, aVF, V3, and V5 (all p &lt; 0.05). (3) Follow-up: Compared with the non-response group, the therapeutic response group showed larger \u0394T-wave amplitude in leads III, aVF, V2, V3, V4, and V5, larger Tp-Te interval difference (\u0394Tp-Te interval) in lead V3, and larger Tp-Te\/QT ratio difference (\u0394Tp-Te\/QT ratio) in lead V3 (all p &lt; 0.05). (4) Receiver operating characteristic curve: \u0394T-wave amplitude in leads III, aVF, V2, V3, V4, and V5, \u0394Tp-Te interval in lead V3, and \u0394Tp-Te\/QT ratio in lead V3 all had predictive value for the therapeutic effect of metoprolol in pediatric POTS (all p &lt; 0.05). Conclusions: \u0394HR and \u0394T-wave amplitude in lead V5 between supine and standing positions are independent risk factors for pediatric POTS. A combination of five indicators\u2014\u0394T-wave amplitude in leads V2, V3, and V5, \u0394Tp-Te interval in lead V3, and \u0394Tp-Te\/QT ratio in lead V3 between supine and standing ECGs\u2014exerts a good predictive effect on the therapeutic response of pediatric POTS to metoprolol intervention.<\/jats:p>","DOI":"10.3390\/jcm15051798","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T10:41:02Z","timestamp":1772188862000},"page":"1798","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Changes of T-Wave Amplitude and Tp-Te Interval in the Supine and Standing Electrocardiograms of Pediatric Postural Orthostatic Tachycardia Syndrome and Their Predictive Value for the Intervention Effect of Metoprolol"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5095-1435","authenticated-orcid":false,"given":"Shuo","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Pediatric Cardiovasology, Children\u2019s Medical Center, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Changsha 410011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ting","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiovasology, Children\u2019s Medical Center, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Changsha 410011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiovasology, Children\u2019s Medical Center, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Changsha 410011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1627-8918","authenticated-orcid":false,"given":"Yuwen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiovasology, Children\u2019s Medical Center, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Changsha 410011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiovasology, Children\u2019s Medical Center, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Changsha 410011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0322-1664","authenticated-orcid":false,"given":"Liqun","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiovasology, Children\u2019s Medical Center, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Changsha 410011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6955-670X","authenticated-orcid":false,"given":"Chuan","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiovasology, Children\u2019s Medical Center, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Changsha 410011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Runmei","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiovasology, Children\u2019s Medical Center, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Changsha 410011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7120-0654","authenticated-orcid":false,"given":"Cheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiovasology, Children\u2019s Medical Center, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Changsha 410011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1093\/europace\/euw154","article-title":"Antiadrenergic autoimmunity in postural tachycardia syndrome","volume":"19","author":"Fedorowski","year":"2017","journal-title":"Europace"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1007\/s12519-024-00819-w","article-title":"Guidelines for the diagnosis and treatment of neurally mediated syncope in children and adolescents (revised 2024)","volume":"20","author":"Wang","year":"2024","journal-title":"World J. 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