Heart failure with preserved ejection fraction (HFpEF) in children

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 ,&nbsp;L. Houyel ,&nbsp;D. Khraiche ,&nbsp;Z. Belhadjer ,&nbsp;J. Grynblat ,&nbsp;A. Neuraz ,&nbsp;N. Garcelon ,&nbsp;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> <!-->&lt;<!--> <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> <!-->&lt;<!--> <!-->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> <!-->&lt;<!--> <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":null,"pages":null},"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.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
保留射血分数(HFpEF)的儿童心力衰竭
射血分数保留的心力衰竭(HF)是一种复杂的心脏病,由心脏充盈的结构或功能损伤引起。它在老年人中有很高的患病率,但很少在儿童中进行分析。目的通过应用于大型三级医院数据库的专用算法,识别无分流或流出道阻塞的双心室生理性儿童的HFpEF,并描述该人群的病因、血液动力学特征、治疗和艰难结局。方法我们应用临床、超声心动图和血液动力学测量相结合的方法来确认HFpEF的诊断,以确定从儿科医院数据仓库中提取的具有确诊HFpEF表型的儿童。结果/预期结果总共包括137例HFpEF病例。平均年龄7±5.7岁。HFpEF的心血管原因是肥厚型心肌病(44%)、限制性心肌病(RCM)(32%)、重复心脏手术引起的心肌病(10%)、扩张型心肌病(7%)和缩窄性心包炎(7%)(图1)。患有RCM的儿童预后最差(27%的10年无移植生存率,P<;0.005)。平均患者随访5.3年。43%的患者因急性HF住院,12%的患者接受了移植,31%的患者死亡。NT-proBNP在所有组中均增加,并与死亡率和移植相关,HR 1.91(95%CI 1.31,2.76,p值<;0.001)。根据超声心动图评估,56%的患者被诊断为肺动脉高压(PH),与死亡率和植入相关,HR 2.84(95%CI 1.58,5.10,P<;0.001)。在48名接受右心导管插入术的患者中,毛细血管后或合并PH最常见,但15%的单独毛细血管前PH患者的预后较差,HR 4.60(95%CI 1.46,14.5,P=0.009)。年龄较小、RCM、急性HF发作、NT-proBNP增加与硬预后相关。PH患者的毛细血管前成分与较差的预后有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
Archives of Cardiovascular Diseases Supplements
Archives of Cardiovascular Diseases Supplements CARDIAC & CARDIOVASCULAR SYSTEMS-
自引率
0.00%
发文量
508
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.
期刊最新文献
Editorial Contents How to Report postoperative pediatric cardiac surgery? Review and analysis of the literature Surgical or transcatheter pulmonary valve replacement, how to choose ? No coronary artery in the aorta: Severe congenital malformation under-diagnosed
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1