title: Outcomes of children following a first hospitalization for dilated cardiomyopathy.
abstract: BACKGROUND
  We hypothesized that children with dilated cardiomyopathy who require hospital admission are at increased risk for death or transplantation during their first hospitalization and in the first year that follows. We also assessed the value of routine data collected during that time to predict death or the need for transplantation prior to discharge and within 1 year of admission.
  
  
  RESULTS
  We conducted a retrospective review of 83 pediatric patients with dilated cardiomyopathy whose initial hospitalization fell between 2004 and 2009. The mean age at hospitalization was 7 years. The majority of patients demonstrated moderate or severe left ventricular dysfunction on initial echocardiogram (80%) and/or the need for intravenous inotropes within 7 days of hospital admission (69%). Five patients (6%) died, and 15 (18%) were transplanted in the initial hospitalization. At 1 year, 11/71 (15%) had died, and 27/71 (38%) were transplanted. The overall freedom from death, transplantation, or rehospitalization at 1 year following admission was 21%. Fractional shortening, left ventricular ejection fraction, serum cholesterol, uric acid, mixed venous saturation, and atrial filling pressures were all predictive of death or transplantation during the initial hospitalization. Left ventricular ejection fraction was predictive of death or transplantation at 1 year.
  
  
  CONCLUSIONS
  The first hospitalization for dilated cardiomyopathy marks a period of high risk for clinical decline, end stage heart failure, and the need for cardiac transplantation. Echocardiographic function and hemodynamic and serum measurements may aid in predicting outcomes. Despite medical management, most patients will be rehospitalized and/or require cardiac transplantation within 1 year of admission.
authors.affiliation: Department of Pediatrics, Stanford University Medical Center, 750 Welch Road, , Palo Alto, CA 94304, USA. Seth.Hollander@stanford.edu
authors.forename: Seth A
authors.initials: SA
authors.lastname: Hollander
authors.forename: Daniel
authors.initials: D
authors.lastname: Bernstein
authors.forename: Justin
authors.initials: J
authors.lastname: Yeh
authors.forename: Duy
authors.initials: D
authors.lastname: Dao
authors.forename: Heather Y
authors.initials: HY
authors.lastname: Sun
authors.forename: David
authors.initials: D
authors.lastname: Rosenthal
mesh_terms: D000293:Adolescent; D000367:Age Factors; D016275:Atrial Function; D015415:Biomarkers / Q000097:blood; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood; D003661:Decision Support Techniques; D005260:Female; D016027:Heart Transplantation / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D010359:Patient Readmission; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D014527:Uric Acid / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D014527:Uric Acid; D002784:Cholesterol