Evolution issues in pediatric dilated cardiomypathy in children

Abstract

Aim. Cardiomyopathy presents a heterogeneous group of myocardial disorders. Dilated cardiomyopathy (DCM) is the most common pediatric primary cardiomyopathy. The annual incidence of DMC in children is, according to different authors, from 0.57 to 2.6 / 100,000 pediatric population. The authors mention a higher incidence for children aged up to 1 year and is prevalent at boys. Evaluation of children with DCM includes clinical and instrumental parameters, especially the left ventricular (LV) function. The aim of the study was to evaluate echocardiographic evaluation of children with DCM. Material and methods. The study included a total of 75 children with primary cardiomyopathy (45 boys and 30 girls), aged 1 month - 18 years (mean age - 4.81 ± 2.42 years) consecutively admitted in cardiology department of Mother and Child Institute (Chisinau, Moldova). The diagnosis was confirmed through clinical methods and explorative complex tests: anamnestic (relationship-onset symptomatic viral infection, family history), general clinical examination, chest radiography, electrocardiography (ECG), EcoCG at rest, laboratory tests to determine the specific enzyme activity in myocardial cells. Average duration of patient follow-up was 12 months. The entire group of patients was then divided according to clinical diagnosis: group I - 40 patients with the diagnosis of myocarditis (17 girls, 23 boys), and group II - 35 DCM children (9 girls, 26 boys). There were not significant differences by gender and average age between groups. Results and discussion. Initial clinical general manifestations more pronounced in the group were fatigability (90.6%) and dyspnea (46.6%). Analysis of demographic, clinical and laboratory parameters revealed apparent prevalence of boys, the presence of cardiomegaly, and frequent association of general signs of cardiac insufficiency (ICC grade II-III NYHA / Ross). We determined to improve clinical status in terms of functional class NYHA / Ross. Patients with myocarditis (group I) had a better prognosis, which showed improvement of LV myocardial function in over 90% of the analyzed cases. At the same time, children with DCM showed different signs of ICC degree, of which 3 (11.4%) died in 4-6 months after primary presentation, and 2 children were included in the waiting list for heart transplantation ICC due to progression of degree of ventricular dysfunction (Table 1). Table 1. Assessing of EcoCG parameters in children with myocarditis and DCM Parameters Iniţial 3 month 12 month DTDVS, mm (M±m) Group I Group II 38,51±2,1 39,32±1,2 36,4±2,3* 37,62±1,4 36,14±1,7* 36,33±1,6* DTSVS, mm (M±m) Group I Group II 25,91±1,5 26,85±1,3 25,21±2,1 25,23±2,3 23,36±2,1* 23,91±1,7** SIV, mm (M±m) Group I Group II 5,81±0,4 6,46±0,3 5,35±0,2◊ 6,34±0,4 5,21±0,3*◊ 6,24±0,4 FE, % (M±m) Group I Group II 35,32±3,1◊ 27,18±8,1 42,4±1,13*◊ 32,21±4,2* 48,63±1,34** 41,24±1,82** FS, % (M±m) Group I Group II 20,32±2,3 18,21±4,3 23,5±3,1* 23,2±3,1* 24,3±1,17** 26,7±3,24** Index Tei (IT) (M±m) Group I Group II 0,44±0,2 0,50±0,2 0,38±0,18*◊ 0,46±0,1 0,33±1,15**◊ 0,42±0,02** Note: a) DTDVS-enddiastolic diameter of the LV; DTSVS-endsystolic diameter of the LV, SIV- interventricular septum, b) compared to baseline - * p <0.05, ** p <0, 01, ◊ - p <0.05 - the difference between parameter changes in groups I and II evaluation stages. Conclusions: 1. The etiology of primary cardiomyopathy in children is heterogeneous, the data of our study confi rmed contact with fl u-like infectious in 50.6% of cases. 2. Acute myocarditis can associate a transient LV dysfunction, which recovered in the fi rst 3 months of treatment in most cases (90.6%). 3. EcoCG measurements: FE, FS, and Tei index (TI) are easy to calculate, and are useful in assessing LV performance in children both in establishing the initial diagnosis and the clinical evaluation of patients with myocarditis and DCM, independent of the clinical signs of ICC.