Outcome Predictors for Pediatric Dilated Cardiomyopathy: A Systematic Review.
Dilated cardiomyopathy comprises the largest group of pediatric cardiomyopathy functional types and is the most common indication for heart transplant in children over 5 years old. Prognostic factors for this condition have long been sought by many researchers. In a systematic review of these factors, we found 32 relevant articles published since 1976. Four studies report finding no predictive factors. In the remaining 28 studies, several factors indicating better prognosis stand out across multiple articles: younger age at diagnosis, higher left-ventricular fractional shortening and ejection fraction, and the presence of myocarditis. Results for other factors conflict across studies: severe mitral regurgitation, arrhythmias, and a family history of cardiomyopathy. Elevated left-ventricular end diastolic pressure was statistically significant in two studies, but it may be of limited utility as a result of its invasiveness. Although most children have congestive heart failure at presentation, only two studies found it to be a significant predictor of mortality. The largest study of this factor qualified the increased risk to 1 year after presentation. Other significant predictors that have not been analyzed or reported by more than one study group, are right ventricular failure and impaired cardiac adrenergic innervation, as detected by radiolabeled meta-iodobenzylguanidine imaging. Although 1- and 5-year survival rates have steadily improved, as more children with DCM receive cardiac transplants, event-free survival rates (the absence of "heart death" resulting in death or transplant) are similar to those from decades ago. A unified risk algorithm may assist in clinical decision-making but requires more studies. Other studies are needed to assess the post-transplant survival experience.
Alvarez
Jorge A
JA
Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL USA.
Wilkinson
James D
JD
Lipshultz
Steven E
SE
J Korean Med Sci. 2004 Oct;19(5):652-5
15483338
J Am Coll Cardiol. 1991 Jul;18(1):152-6
2050918
Jpn Heart J. 1990 Nov;31(6):789-97
2084276
Heart. 2004 Aug;90(8):908-15
15253966
Am Heart J. 1994 Jul;128(1):133-6
8017266
Arq Bras Cardiol. 2004 Jun;82(6):505-14
15257368
N Engl J Med. 2003 Apr 24;348(17):1639-46
12711738
Am J Cardiol. 1991 Nov 15;68(13):1372-6
1835279
Br Heart J. 1994 Sep;72(3):246-50
7946775
J Heart Lung Transplant. 1994 Jul-Aug;13(4):S107-12
7947865
J Am Coll Cardiol. 1985 Nov;6(5):1126-31
4045036
Circulation. 1994 Sep;90(3):1310-8
8087940
J Heart Lung Transplant. 2001 Nov;20(11):1152-7
11704474
J Am Coll Cardiol. 1988 Jan;11(1):139-44
3275703
Eur Heart J. 1987 Feb;8(2):100-5
3569307
Am J Cardiol. 1988 Sep 1;62(7):431-4
3414520
J Am Coll Cardiol. 1990 Jan;15(1):194-5
2295733
Am J Cardiovasc Pathol. 1987 Jan;1(1):3-14
3455232
J Chin Med Assoc. 2005 Aug;68(8):368-72
16138715
Am Heart J. 1991 Jul;122(1 Pt 1):126-31
1829567
Pediatr Cardiol. 1995 Mar-Apr;16(2):56-60
7540289
Eur Heart J. 1996 Aug;17(8):1233-8
8869865
Br Heart J. 1994 Oct;72(4):360-3
7833195
AMA Am J Dis Child. 1953 Jul;86(1):28-44
13057357
Circulation. 1996 Mar 1;93(5):841-2
8598070
Int J Cardiol. 1998 Jul 1;65(2):125-8
9706806
Int J Cardiol. 2001 Apr;78(2):135-41
11334657
Am Heart J. 1991 May;121(5):1502-6
2017982
Rev Port Cardiol. 2000 Feb;19(2):191-200
10763348
JAMA. 2006 Oct 18;296(15):1867-76
17047217
Acta Cardiol. 2006 Apr;61(2):169-74
16716018
J Am Coll Cardiol. 2004 Jul 21;44(2):391-7
15261937
Circulation. 1997 Jan 7;95(1):133-9
8994428
J Am Coll Cardiol. 1999 Dec;34(7):2105-10
10588231
J Am Coll Cardiol. 1990 Jan;15(1):189-93
2295732
Pediatrics. 1998 Mar;101(3 Pt 1):369-76
9480999
Arch Mal Coeur Vaiss. 1991 May;84(5):721-6
1898208
Am J Cardiol. 1991 Aug 1;68(4):365-9
1858677
Am J Epidemiol. 1997 Sep 1;146(5):385-93
9290498
Circulation. 2006 Dec 12;114(24):2671-8
17116768
Br Heart J. 1980 Dec;44(6):672-3
7459150
Curr Opin Cardiol. 1998 May;13(3):179-84
9649940
N Engl J Med. 2003 Apr 24;348(17):1647-55
12711739
J Heart Lung Transplant. 2006 Aug;25(8):893-903
16890109
Am J Cardiol. 1968 Feb;21(2):153-65
5638189
Am J Cardiol. 1988 Sep 1;62(7):468-70
3414525
Heart. 2001 Jun;85(6):692-6
11359754
Am Heart J. 1976 Nov;92(5):549-60
136183
Pediatr Cardiol. 1994 May-Jun;15(3):121-6
8047493
J Pediatr (Rio J). 2004 Jan-Feb;80(1):71-6
14978553