Como o ecocardiograma pode ser útil em predizer a morte em crianças com cardiomiopatia dilatada idiopática?

Abstract

510Idiopathic dilated cardiomyopathy in children is an important cause of heart failure in the absence of congenital heart disease. It accounts for up to 29% of the medical interventions before the age of 2 years 1 , and its mortality rates range from 16% 2 in 10 years to 49% 3 , 66% 4 , and 80% 5 in 5 years. Cardiac transplantation is the treatment of choice in patients who do not respond to clinical treatment. The survival rates in cardiac transplantation range from 75 to 80% in 1 year, and from 60 to 75% in 5 years [6][7][8] . Several international studies 2-4,9-11 were carried out to determine the indicators of an unfavorable prognosis, helping in the early indication of cardiac transplantation. The echocardiogram is an important tool not only for the diagnosis and follow-up of idiopathic dilated cardiomyopathy, but also for the indication of cardiac transplantation, despite the lack of consensus in the results [12][13][14][15][16] .Aiming at determining echocardiographic predictors of death in children with idiopathic dilated cardiomyopathy, a retrospective study was carried out comprising all children admitted to the Instituto Nacional de Cardiologia Laranjeiras over a period of 24 years, and their evolutional echocardiographic data in the period were analyzed. Suspected risk factors were selected and submitted to statistical analysis. MethodsThe databank was consulted for the retrospective analysis of 148 consecutive patients with idiopathic dilated cardiomyopathy diagnosed between September 1979 and March 2003. The echocardiographic results of all patients were analyzed.The criterion of inclusion was the presence of heart failure associated with cardiomegaly on chest teleradiography or left ventricular dilation, or both, with a reduction in contractility visualized on M mode echocardiography in the first 8 patients and on 2-dimensional echocardiography in the remaining 140 cases. In the latter, 5-and 7.5-MHz transducers were used to enable the visualization of the origin and initial bifurcations of the coronary arteries. Patients with the following characteristics were excluded from the study: congenital heart diseases; anomalous origin of the coronary arteries; Kawasaki's disease; ventricular arrhythmogenic cardiomyopathy; ischemic lesion due to neonatal asphyxia or following cardiopulmonary resuscitation; use of an antineoplastic drug; inborn errors of metabolism; primary arrhythmias; orovalvular lesions due to rheumatic disease; neuromuscular diseases; syste- ObjectiveTo determine the echocardiographic predicting factors of death in children with idiopathic dilated cardiomyopathy. MethodsA retrospective study of 148 children with idiopathic dilated cardiomyopathy diagnosed between September 1979 and March 2003 was carried out. The inclusion criteria were as follows: heart failure and a reduction in contractility on the echocardiogram in the absence of congenital or secondary heart disease. Four hundred and seventy examinations during a period of 244.8 months of evolution were analyzed. The following ...

Cardiomiopatia dilatada em crianças: existe um preditor ecocardiográfico de prognóstico?

“…15 Mais recentemente, a ecocardiografia sob estresse com dobutamina tem sido utilizada para avaliar reserva contrátil miocárdica em pacientes com miocardiopatia dilatada (adolescentes e adultos), porém o seu valor prognóstico não foi relevante 21 . A ecocardiografia tem fornecido informações detalhadas sobre o diagnóstico e gravidade dos pacientes com cardiomiopatia dilatada, porém, infelizmente, devido ao pequeno número de pacientes estudados, não há, no momento, como identificar parâmetros preditivos de evolução.…”