title: A Clinical Risk Score to Improve the Diagnosis of Tachycardia-Induced Cardiomyopathy in Childhood.
abstract: Tachycardia-induced cardiomyopathy (TIC) is a treatable cause of heart failure in children, but there is little information as to which clinical variables best discriminate TIC from other forms of cardiomyopathy. TIC cases with dilated cardiomyopathy (DC) from 16 participating centers were identified and compared with controls with other forms of DC. Presenting clinical, echocardiographic, and electrocardiographic characteristics were collected. Heart rate (HR) percentile was defined as HR/median HR for age, and PR index as the PR/RR interval. P-wave morphology (PWM) was defined as possible sinus or nonsinus based on a predefined algorithm. Eighty TIC cases and 135 controls were identified. Cases demonstrated lower LV end-diastolic diameter and LV end-systolic diameter than DC controls (4.3 vs 6.5, p <0.001; 7.4 vs 10.9, p <0.001) and were less likely to receive inotropic medication at presentation (p <0.001 for both). Multivariable logistic regression identified HR percentile (OR 2.1 per 10% increase, CI 1.3 to 4.6; p = 0.014), PR index (OR 1.2, CI 1.1 to 1.4; p = 0.004), and nonsinus PWM (OR 104.9, CI 15.2 to 1,659.8; p <0.001) as predictive of TIC status. A risk score using HR percentile >130%, PR index >30%, and nonsinus PWM was associated with a sensitivity of 100% and specificity of 87% for the diagnosis of TIC. Model training and validation area under the curves were similar at 0.97 and 0.94, respectively. In conclusion, pediatric TIC may be accurately discriminated from other forms of DC using simple electrocardiographic parameters. This may allow for rapid diagnosis and early treatment of this condition.
authors: Depatment of Pediatrics, University of California at Los Angeles Medical Center, Los Angeles, California. Electronic address: jpmoore@mednet.ucla.edu.
authors: Jeremy P
authors: JP
authors: Moore
authors: Depatment of Pediatrics, University of California at Los Angeles Medical Center, Los Angeles, California.
authors: Shuo
authors: S
authors: Wang
authors: Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington.
authors: Erin L
authors: EL
authors: Albers
authors: Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington.
authors: Jack C
authors: JC
authors: Salerno
authors: Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
authors: Elizabeth A
authors: EA
authors: Stephenson
authors: Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Maully J
authors: MJ
authors: Shah
authors: The Royal Children's Hospital, Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia.
authors: Andreas
authors: A
authors: Pflaumer
authors: Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital, Cincinnati, Ohio.
authors: Richard J
authors: RJ
authors: Czosek
authors: Department of Pediatrics, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah.
authors: Jason M
authors: JM
authors: Garnreiter
authors: Division of Cardiology, Children's Hospital Colorado, Aurora, Colorado.
authors: Kathryn
authors: K
authors: Collins
authors: Arizona Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, Arizona.
authors: Andrew L
authors: AL
authors: Papez
authors: Division of Pediatric Cardiology, University of British Columbia, British Columbia, Canada.
authors: Shubhayan
authors: S
authors: Sanatani
authors: Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
authors: Nicole B
authors: NB
authors: Cain
authors: Department of Pediatrics, Vanderbilt University School of Medicine, The Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors: Prince J
authors: PJ
authors: Kannankeril
authors: Rady Children's Hospital San Diego, University of California at San Diego, La Jolla, California.
authors: James C
authors: JC
authors: Perry
authors: Division of Pediatric Cardiology, Loma Linda University Children's Hospital, Loma Linda, California.
authors: Ravi
authors: R
authors: Mandapati
authors: Division of Pediatric Cardiology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri.
authors: Jennifer N A
authors: JN
authors: Silva
authors: Department of Pediatrics, Oregon Health and Science University, Portland, Oregon.
authors: Seshadri
authors: S
authors: Balaji
authors: Depatment of Pediatrics, University of California at Los Angeles Medical Center, Los Angeles, California.
authors: Kevin M
authors: KM
authors: Shannon
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D006339:Heart Rate; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012042:Registries; D018570:Risk Assessment; D013318:Stroke Volume; D013610:Tachycardia / Q000150:complications / Q000175:diagnosis*
chemical_list: D002316:Cardiotonic Agents