Improved prognosis of heart failure due to idiopathic dilated cardiomyopathy in children

Venugopalan, P; Agarwal, AK; Akinbami, Felix O.; Nour, I.B El; Subramanyan, Raghavan

doi:10.1016/s0167-5273(98)00084-9

Cited by 26 publications

(23 citation statements)

References 16 publications

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“…19,24,30 There was no observed difference in incidence according to sex, 18 which is in agreement with published data. [8][9][10][11][12]24,25,29,31,32 Sex did not influence mortality in this series, 18 which is in agreement with other authors. 12,20,29 Previous viral disease had been present in 37.6% of patients, 18 with viral infection rates in published literature being between 4.8% 19 and 54.2%.…”

Section: Discussionsupporting

confidence: 91%

O impacto da desnutrição na cardiomiopatia dilatada idiopática na infância

Azevedo

Filho

Santos

et al. 2004

J. Pediatr. (Rio J.)

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Objective: To analyze the prognostic value of malnutrition in children with idiopathic dilated cardiomyopathy.Methods: This is a retrospective study of 165 patients with idiopathic dilated cardiomyopathy, diagnosed from September 1979 to March 2003. It analyzed the following variables: gender, age, previous viral illness in the preceding 3 months, functional class according to the New York Heart Association (NYHA), evaluation of nutritional status (normal vs malnutrition), percentile and standard deviation (z index) of weight. Weight was measured 744 times during the first 72 months, 93 during the first month. Statistical analysis was performed by chi-squared, Student t test and analysis of variance for repeated measures (ANOVA). Ninety-five percent confidence intervals (CI95) and odds ratios (OR) were calculated. An alpha value of 0.05 and beta of 0.80 were used.Results: Mean age at presentation was 2.2±3.2 years with higher incidence in those younger than 2 years (75.8%-CI95 = 68.5% to 82.1%) (p < 0.0001). NYHA classes III and IV were observed in 81.2% (CI95 = 74.4% to 86.9%) (p < 0.0001) and all 40 deaths were this group (p = 0.0008). At presentation, myocarditis occurred in 39.4% (CI95 = 31.9% to 47.3%) (p = 0.0001) and a high level of association between myocarditis and previous viral illness was observed (p = 0.0005) (OR = 3.15-CI95 = 1.55 to 6.44). Malnutrition at presentation did not influence death (p = 0.10), however progressive malnutrition was a marker for death (p = 0.02) (OR = 3.21-CI95 = 1.04 to 9.95). No significant differences weight percentiles (p = 0.15) or in z scores (p = 0.14) were observed. Observed mean weight percentiles (34.9±32.6 vs 8.6±16.0) (p < 0.0001) and z scores (-0.62±1.43 vs 2.02±1.12) (p < 0.0001) during the study period were greater among survivors. ANOVA demonstrated significant differences in weight percentile progression (p = 0.0417) and z scores (p = 0.0005) from the first month onwards. Conclusion:The evaluation of nutritional status. is easy to performer, it does not imply additional costs and should become routine for children with chronic heart failure.J Pediatr (Rio J). 2004;80(3):211-6: Dilated cardiomyopathy, children, malnutrition, heart failure.

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Section: Discussionsupporting

confidence: 91%

O impacto da desnutrição na cardiomiopatia dilatada idiopática na infância

Azevedo

Filho

Santos

et al. 2004

J. Pediatr. (Rio J.)

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“…In this study, the mean age was 2.37 years 21 , similar to that reported in most studies in the literature 3,4,10,22,[23][24][25][26][27][28] , although some authors reported greater means 2,5,14,24 . In our sample, the disease started preferably below the age of 2 years (73.0%) 21 .…”

Section: Discussionsupporting

confidence: 86%

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

Azevedo

Filho

Santos

et al. 2004

Arq. Bras. Cardiol.

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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 ...

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“…18,23,28 No difference was observed as to the incidence of the disease with regard to gender, 17 which is in agreement with the available literature. [7][8][9][10][11]23,27,[29][30][31] Gender did not show to have any influence on mortality in this study, 17 which is in line with the findings of other authors. 11,19,27 CTR was evaluated at diagnosis and at 1, 3, 6, 12, 18, 24, 36, 48, 60 and 72 months.…”

Section: Cardiothoracic Ratio (Ctr)supporting

confidence: 90%

“…In the literature, the incidence of cardiomegaly has been reported to be between 75.0% and 100%, 29,32 depending on the severity of the studied patients; no association between cardiomegaly and death was reported. Pulmonary congestion was described by Arola et al 10 in 78.0% of patients, being a predictor of poorer outcome (p = 0.06).…”

Section: Discussionmentioning

confidence: 86%

“…In the study conducted in Poland, 22 no difference was noted as to the distribution of disease severity and as to FC between the survivor and nonsurvivor groups. Silva et al 29 showed predominance of less severe cases (FC I and II), but they do not mention anything about the influence of FC on mortality. Patients whose disease is classified as FC III and IV right at the beginning and who do not respond to clinical treatment are more likely to die.…”

Section: Discussionmentioning

confidence: 95%

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O valor prognóstico da telerradiografia de tórax na cardiomiopatia dilatada idiopática na infância

Azevedo¹,

Filho²,

Santos³

et al. 2004

J. Pediatr. (Rio J.)

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Objective: To analyze the prognostic value of cardiomegaly, pulmonary congestion and cardiothoracic ratio as indicators of death and survival in children with idiopathic dilated cardiomyopathy (IDCM). Methods:We carried out a retrospective review of 152 patients with idiopathic dilated cardiomyopathy diagnosed between September 1979 and March 2003. In the first 72 months, 722 exams were performed (100 in the first 15 days). Statistical analysis: chi-square, Student s t test, ANOVA and Kaplan-Meier curves. Alpha = 0.05; beta = 0.80. Results:The mean age at presentation was 2.2±3.2 years. Idiopathic dilated cardiomyopathy incidence was higher in children younger than 2 years (76.3% 95% CI = 68.7% to 82.8%) (p < 0.0001). Sex (p = 0.07) and color (p = 0.11) were not significant and mortality was not influenced by age (p = 0.73), sex (p = 0.78) or color (p = 0.20). Most patients were severely ill (84.2% 95% CI = 77.4% to 89.6%; functional class III and IV; p < 0.0001). All 43 deaths occurred in this group (p = 0.0008). Cardiomegaly at presentation was observed in 94.1% (95% CI = 89.1% to 97.2%) (p < 0.0001), and pulmonary congestion in 75.6% (95% CI = 68.0% to 82.2%) (p < 0.0001). Pulmonary congestion and cardiomegaly were more frequent in functional class III/IV patients (RC = 8.03 95% CI = 2.85% to 23.1%) (p < 0.0001). Pulmonary congestion was a marker of death (RC = 3.16 95% CI = 1.06% to 10.07) (p = 0.0222), but not cardiomegaly (p = 0.1185). Survival was influenced by both cardiomegaly (p = 0.0189) and pulmonary congestion (p = 0.0050). Mean and maximum cardiothoracic ratio were higher in the death group (0.749±0.053 vs. 0.662±0.080) (p < 0.0001) and (0.716±0.059 vs. 0.620±0.085) (p < 0.0001). ANOVA revealed a progressive decrease in cardiothoracic ratio in the survival group (p < 0.0001). Conclusion:In children with idiopathic dilated cardiomyopathy, the presence of pulmonary congestion at presentation and increased cardiothoracic ratio are associated with poor survival.J Pediatr (Rio J). 2004;80(1):71-6: Idiopathic dilated cardiomyopathy, child, radiology.

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Improved prognosis of heart failure due to idiopathic dilated cardiomyopathy in children

Cited by 26 publications

References 16 publications

O impacto da desnutrição na cardiomiopatia dilatada idiopática na infância

O impacto da desnutrição na cardiomiopatia dilatada idiopática na infância

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

O valor prognóstico da telerradiografia de tórax na cardiomiopatia dilatada idiopática na infância

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