Key result
Severe heart failure at diagnosis is linked to ~127% greater mortality in children with DCM.
Why the study?
Heart failure is a common complication in children with dilated cardiomyopathy, but whether severe heart failure at diagnosis is related to poor outcomes required determination.
Does severe heart failure at diagnosis increase the risk of death in children with dilated cardiomyopathy compared to mild heart failure?
Cohort (n=121)
No
Does severe heart failure at diagnosis increase the risk of death in children with dilated cardiomyopathy compared to mild heart failure?
Effect estimate: HR 2.27 (95% CI 1.280-4.038)
Absolute Event Rate: 79.2% vs 46.1%
p-value: p=<0.005
In children with dilated cardiomyopathy, presenting with severe heart failure at diagnosis is independently associated with a more than two-fold increased risk of death, highlighting the critical need for targeted heart failure management in this population.
May aid risk stratification at diagnosis in pediatric dilated cardiomyopathy; leaves open need for prospective validation before guiding care.
Objective Heart failure is a common complication in children with dilated cardiomyopathy. The aim of this study was to determine whether severe heart failure at diagnosis was related to poor outcomes in children with dilated cardiomyopathy. Methods We analyzed medical data from 121 children with dilated cardiomyopathy in our hospital from 2003 to 2021. The children were grouped by the degree of heart failure. Cox regression analysis was performed to confirm whether severe heart failure was associated with poor outcomes. Results There were 121 patients with dilated cardiomyopathy in this research. The mean age of the 121 patients was 118.5 ± 63.0 months. Of these patients, 81 (67.8%) were sorted into a severe heart failure group and 39 (32.2%) were placed into a mild heart failure group. A comparison between the two groups showed that patients with severe heart failure were older and more likely to be male, have lower systolic blood pressure measurements, be admitted to the intensive care unit and be treated with β-blockers, loop diuretics, spironolactone and digoxin. In addition, they had larger systolic and diastolic left ventricular end-diastolic dimensional and lower left ventricular ejection fractional z-scores as well as being more prone to aortic and tricuspid regurgitations (P < 0.05 in all cases). After adjusting for age, sex, heart rate, left ventricular ejection fraction z-scores and drug, severe heart failure was found to be independently associated with an increased risk of death (hazard ratio [HR] 2.27; P < 0.005). Conclusions Severe heart failure at diagnosis was related to a greater risk of death in children with dilated cardiomyopathy. Further prospective studies are warranted to evaluate the efficacy between the treatment undertaken for heart failure and outcomes in children with dilated cardiomyopathy.
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Chen et al. (2022) conducted a cohort in Dilated cardiomyopathy (n=121). Severe heart failure (ROSS/NYHA class III/IV) vs. Mild heart failure (ROSS/NYHA class I/II) was evaluated on Death (HR 2.27, 95% CI 1.280-4.038, p=<0.005). Severe heart failure at diagnosis was independently associated with an increased risk of death (HR 2.27) compared to mild heart failure in children with dilated cardiomyopathy.
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