S. Quennelle , L. Houyel , D. Khraiche , Z. Belhadjer , J. Grynblat , A. Neuraz , N. Garcelon , D. Bonnet
{"title":"Heart failure with preserved ejection fraction (HFpEF) in children","authors":"S. Quennelle , L. Houyel , D. Khraiche , Z. Belhadjer , J. Grynblat , A. Neuraz , N. Garcelon , D. Bonnet","doi":"10.1016/j.acvdsp.2023.07.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Heart failure (HF) with preserved ejection fraction (HFpEF) is a complex cardiac condition that results from a structural or functional impairment of filling of the heart. It has a high prevalence in elderly but has rarely been analyzed in children.</p></div><div><h3>Objective</h3><p>To identify HFpEF in children with biventricular physiology without shunt or outflow tract obstruction, through a dedicated algorithm applied to a large tertiary hospital database, and to describe the causes, hemodynamic<span> profiles, treatment, and hard outcomes of this population.</span></p></div><div><h3>Methods</h3><p>We applied a combination of clinical, echocardiographic, and hemodynamic measurements to confirm the diagnosis of HFpEF to identify children with a confirmed HFpEF phenotype extracted from a pediatric hospital data warehouse.</p></div><div><h3>Results/Expected results</h3><p>In total, 137 HFpEF cases were included. Mean age was 7<!--> <!-->±<!--> <span><span>5.7 years. The cardiovascular causes of HFpEF were hypertrophic cardiomyopathy (44%), </span>restrictive cardiomyopathy<span> (RCM) (32%), cardiomyopathy due to repeated cardiac surgeries (10%), dilated cardiomyopathy (7%), and constrictive pericarditis (7%) (</span></span><span>Figure 1</span>). Children with RCM had the worst prognosis (27% ten years transplant-free survival, <em>P</em> <!--><<!--> <span>0.005). Mean patient follow-up was 5.3 years. 43% of the patients were hospitalized for acute HF, 12% were transplanted and 31% died. NT-proBNP increase was found in all groups and was associated with mortality and transplantation, HR 1.91 (95% CI 1.31, 2.76, p-value</span> <!--><<!--> <!-->0.001). Based on echocardiographic evaluation, 56% of the patients were diagnosed with pulmonary hypertension (PH), associated with mortality and transplantation, HR 2.84 (95% CI 1.58, 5.10, <em>P</em> <!--><<!--> <span>0.001). In the 48 patients who underwent right heart catheterization, post-capillary or combined PH were the most frequent but the 15% with isolated pre-capillary PH had poorer outcomes, HR 4.60 (95% CI, 1.46, 14.5, </span><em>P</em> <!-->=<!--> <!-->0.009).</p></div><div><h3>Conclusion/Perspectives</h3><p>HFpEF is a rare and concerning condition in children. Younger age, RCM, acute HF episodes, increased NT-proBNP are associated with hard outcomes. A precapillary component in patients with PH is associated with poorer outcomes.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 4","pages":"Pages 273-274"},"PeriodicalIF":18.0000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases Supplements","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878648023002240","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
Heart failure (HF) with preserved ejection fraction (HFpEF) is a complex cardiac condition that results from a structural or functional impairment of filling of the heart. It has a high prevalence in elderly but has rarely been analyzed in children.
Objective
To identify HFpEF in children with biventricular physiology without shunt or outflow tract obstruction, through a dedicated algorithm applied to a large tertiary hospital database, and to describe the causes, hemodynamic profiles, treatment, and hard outcomes of this population.
Methods
We applied a combination of clinical, echocardiographic, and hemodynamic measurements to confirm the diagnosis of HFpEF to identify children with a confirmed HFpEF phenotype extracted from a pediatric hospital data warehouse.
Results/Expected results
In total, 137 HFpEF cases were included. Mean age was 7 ± 5.7 years. The cardiovascular causes of HFpEF were hypertrophic cardiomyopathy (44%), restrictive cardiomyopathy (RCM) (32%), cardiomyopathy due to repeated cardiac surgeries (10%), dilated cardiomyopathy (7%), and constrictive pericarditis (7%) (Figure 1). Children with RCM had the worst prognosis (27% ten years transplant-free survival, P < 0.005). Mean patient follow-up was 5.3 years. 43% of the patients were hospitalized for acute HF, 12% were transplanted and 31% died. NT-proBNP increase was found in all groups and was associated with mortality and transplantation, HR 1.91 (95% CI 1.31, 2.76, p-value < 0.001). Based on echocardiographic evaluation, 56% of the patients were diagnosed with pulmonary hypertension (PH), associated with mortality and transplantation, HR 2.84 (95% CI 1.58, 5.10, P < 0.001). In the 48 patients who underwent right heart catheterization, post-capillary or combined PH were the most frequent but the 15% with isolated pre-capillary PH had poorer outcomes, HR 4.60 (95% CI, 1.46, 14.5, P = 0.009).
Conclusion/Perspectives
HFpEF is a rare and concerning condition in children. Younger age, RCM, acute HF episodes, increased NT-proBNP are associated with hard outcomes. A precapillary component in patients with PH is associated with poorer outcomes.
期刊介绍:
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.