title: How can the echocardiogram be useful for predicting death in children with idiopathic dilated cardiomyopathy?
abstract: OBJECTIVE
  To determine the echocardiographic predicting factors of death in children with idiopathic dilated cardiomyopathy.
  
  
  METHODS
  A 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 parameters were assessed: left atrial dimension (LAD); left atrium/aorta ratio (LAD/Ao); left ventricular systolic (LVSD) and diastolic (LVDD) dimensions; left ventricular mass (LVmass); right ventricular dimension (RVD); left ventricular ejection fraction (LVEF); left ventricular shortening fraction (% SH); severity of the insufficiency of the atrioventricular and pulmonary valves; and right ventricular systolic (RVSP) and diastolic (RVDP) pressures. The significance level adopted was alpha < 0.05.
  
  
  RESULTS
  The mean age was 2.37 years, and 35 patients died (23.7%--95 CI = 17.1% to 31.2%). The analysis of variance showed the following: LAD (p<0.0001); LAD/Ao (p<0.0001); LVSD (p=0.0061); LVDD (p=0.0086); LVmass (p<0.0001); LVEF (p=0.0074); %SH (p=0.0072); and RVD (p<0.0001). Worsening of mitral (MI) (p=0.0113) and tricuspid (TI) insufficiencies (p=0.0044) were markers of death, and the presence of MI, TI, and moderate/severe pulmonary insufficiency were deleterious to survival. The Cox proportional hazards regression model showed the following independent predictors of death: LAD/Ao (p=0.0487); LVEF (<0.0001); and the presence of moderate/severe MI (p=0.0419).
  
  
  CONCLUSIONS
  Patients with a progressive increase in LAD/Ao, a reduction in LVEF, and progressive worsening of MI, regardless of the clinical treatment, should be considered for early heart transplantation.
authors.affiliation: Instituto Nacional de Cardiologia Laranjeiras and Universidade do Estado do Rio de Janeiro, Brazil. vitoraze@ig.com.br
authors.forename: Vitor Manuel Pereira
authors.initials: VM
authors.lastname: Azevedo
authors.forename: Francisco Manes
authors.initials: FM
authors.lastname: Albanesi Filho
authors.forename: Marco Aurélio
authors.initials: MA
authors.lastname: Santos
authors.forename: Márcia Bueno
authors.initials: MB
authors.lastname: Castier
authors.forename: Bernardo Rangel
authors.initials: BR
authors.lastname: Tura
mesh_terms: D000293:Adolescent; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004452:Echocardiography; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies