LV remodelling (adjusted OR 3.70; 95% CI 1.22-11.24) and higher mean pulmonary arterial pressure were independently associated with moderate heart failure in children with acyanotic CHD.
Observational (n=219)
No
An exploratory prediction model identified LV remodelling and elevated mean pulmonary arterial pressure as independent predictors of moderate heart failure in children with acyanotic congenital heart disease.
Odds Ratio: 3.7 (95% CI 1.22–11.24)
p-value: p=0.021
Background: Heart failure (HF) remains a major complication of acyanotic congenital heart disease (CHD) in children. Evidence integrating clinical and echocardiographic variables for HF severity stratification in pediatric acyanotic CHD remains limited. This study aimed to identify factors associated with moderate HF and develop an exploratory internally validated prediction model. Methods: This retrospective single-center outpatient study included 219 children aged 0–16 years with acyanotic CHD, identified from medical records spanning January 2023 to December 2025. Moderate HF was defined as Ross score 7–9 (≤5 years) or NYHA class III (>5 years). Multivariable analysis was performed using Firth’s penalized logistic regression. Internal validation used bootstrap optimism correction and leave-one-out cross-validation (LOOCV). Model discrimination was assessed using area under the receiver operating characteristic curve (AUC). Results: Moderate HF was identified in 131 patients (59.8%). LV remodelling defined by LVIDD z-score > +2 (adjusted OR 3.70, 95% CI 1.22–11.24; p = 0.021) and higher mean pulmonary arterial pressure (MPAP) (adjusted OR 1.03 per mmHg, 95% CI 1.00–1.06; p = 0.049) were independently associated with moderate HF. Premature birth showed an inverse association with moderate HF (adjusted OR 0.25, 95% CI 0.13–0.48; p < 0.001). The exploratory five-variable model demonstrated acceptable discrimination (apparent AUC 0.780, 95% CI 0.728–0.849; bootstrap-corrected AUC 0.760; LOOCV AUC 0.749, 95% CI 0.681–0.811), with adequate calibration. An MPAP threshold of ≥26.4 mmHg yielded 78.6% sensitivity for moderate HF identification. Conclusions: LV remodelling and elevated MPAP were independently associated with moderate HF in children with acyanotic CHD. The exploratory internally validated model demonstrated acceptable discrimination using routinely available variables. This model is exploratory and not yet ready for clinical use; prospective multicenter external validation is required before any clinical implementation.
Utamayasa et al. (Fri,) conducted a observational in Acyanotic congenital heart disease (n=219). LV remodelling (LVIDD z-score > +2) vs. No LV remodelling was evaluated on Moderate heart failure (Ross score 7-9 or NYHA class III) (OR 3.70, 95% CI 1.22-11.24, p=0.021). LV remodelling (adjusted OR 3.70; 95% CI 1.22-11.24) and higher mean pulmonary arterial pressure were independently associated with moderate heart failure in children with acyanotic CHD.