A single center experience in pediatric cardiomyopathy. Risk factors, outcomes and the effect of levosimendan
Progress in Pediatric Cardiology(2020)
摘要
Cardiomyopathies are the leading cause of heart failure (HF) in children with anatomically intact hearts. A retrospective data analysis of a tertiary cardiac surgery and cardiology center cohort was performed. Our objectives were to analyze demographic, clinical, echocardiographic and hemodynamic data of children with HF due to cardiomyopathy – myocarditis, identify risk factors predictive of outcome and evaluate the possible effect of levosimendan administration. A total of 75 patients were included in the study. Median follow up was 24.1 months [interquartile range (IQR) 8.3–85.9]. Forty nine patients (71%) presented with significant HF (stage III/IV), with dilated cardiomyopathy (DCM) being the predominant diagnosis (74%). Twenty five patients (36%) experienced adverse outcome (defined as the composite endpoint of deterioration, transplantation listing and death), 18 (26%) died and 19 (27%) fully recovered. Severe HF at presentation (stage III/IV), presence of fibrosis on endomyocardial biopsy, intubation during admission at presentation and NT-proBNP values were identified as risk factors for death. Sixteen patients received repeated 24-hour levosimendan infusions [median 12 infusions/patient (IQR 9-24)]. All received a loading dose but one. No hypotensive episodes were recorded during loading or the first 24-hour infusion. Levosimendan administration was associated with significant improvement of left ventricular fractional shortening (LVFS, p = .003) and significant reduction of NT-proBNP values (p = .033). No difference was detected in survival time (combined endpoint of death or transplantation) between patients who received levosimendan and those who did not (log-rank test p-value = .645).
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关键词
ATP,AVVR,BNP,CI,CO,CHD,DCM,ECMO,EF,EMB,FDA,FS,HF,HR,ICD,ICU,IQR,IV,LCOS,LOS,LV,LVEDP,LVEF,LVFS,MCS,NT-proBNP,NYHA,OR,PCR,SD,VAD
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