Key result
A predictive nomogram incorporating age, baseline LVEDD Z-score, and QRS interval accurately predicted left ventricular reverse remodeling in pediatric patients with recent-onset dilated cardiomyopathy, achieving a C-index of 0.903.
Why the study?
Pediatric dilated cardiomyopathy prognosis has improved with pharmacological advances, but significant inter-individual variability in left ventricular reverse remodeling exists, making predictors critical for individualizing management and transplant timing.
Can a nomogram using clinical variables predict left ventricular reverse remodeling in children with recent-onset dilated cardiomyopathy?
Observational (n=146)
No
Can a nomogram using clinical variables predict left ventricular reverse remodeling in children with recent-onset dilated cardiomyopathy?
A novel nomogram incorporating age, LVEDD Z-score, and QRS interval can accurately predict left ventricular reverse remodeling in pediatric patients with dilated cardiomyopathy, potentially guiding individualized management.
May aid risk stratification in pediatric dilated cardiomyopathy; leaves open need for prospective external validation.
BACKGROUND: Pharmacological advances have improved pediatric dilated cardiomyopathy (DCM) prognosis, which manifests as left ventricular reverse remodeling (LVRR). However, significant inter-individual variability exists in therapeutic response. Identifying predictors is critical for individualizing management to inform device and transplant timing. AIM: To develop a nomogram for predicting LVRR in pediatric DCM. METHODS: A retrospective analysis of 146 children hospitalized for DCM from January 2012 to June 2023. 55 exhibited LVRR. A nomogram predicting pediatric DCM-LVRR was developed using univariate analysis and logistic regression to select predictors. The nomogram was validated via bootstrapping and receiver operating characteristic curves for discrimination. Calibration was assessed with the Hosmer-Lemeshow test. Decision curve analysis evaluated performance and utility. RESULTS: Age, left ventricular end-diastolic dimension Z-score, and QRS interval were associated with the occurrence of LVRR. Discrimination was high (C-index 0.903) and internally validated on bootstrapping with 1000 repetitions (Adjusted C-index 0.895). The Hosmer-Lemeshow test revealed no significant deviation between nomogram predictions and outcomes (χ2 = 10.883; P = 0.207). DCA revealed that the model was clinically useful at threshold probabilities > 4%. CONCLUSIONS: We developed and internally validated a nomogram predicting LVRR for pediatric DCM patients, exhibiting high sensitivity, specificity and clinical utility.
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Han et al. (2025) conducted an observational in Recent-onset dilated cardiomyopathy (n=146). Clinical predictors (age, LVEDD Z-score, QRS interval) was evaluated on Left ventricular reverse remodeling (LVRR) (C-index 0.903, 95% CI 0.857-0.950). A predictive nomogram incorporating age, baseline LVEDD Z-score, and QRS interval accurately predicted left ventricular reverse remodeling in pediatric patients with recent-onset dilated cardiomyopathy, achieving a C-index of 0.903.
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