Development of Cardiac Events and Functional Recovery Prediction Models for Pediatric Dilated Cardiomyopathy
Background: Since both the risk of death and the probability of spontaneous functional recovery (FR) coexist in association with pediatric dilated cardiomyopathy (DCMP), management should be based on individualized outcome predictions.Methods: A single-center retrospective review of 105 pediatric pa...
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doaj-1b08d8288be446b5a2d342d8820a18ee2021-09-03T11:19:25ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602021-08-01910.3389/fped.2021.736872736872Development of Cardiac Events and Functional Recovery Prediction Models for Pediatric Dilated CardiomyopathyDong-Hee Kim0Eun Seok Choi1Bo Sang Kwon2Chun Soo Park3Seul Gi Cha4Jae Suk Baek5Jeong Jin Yu6Young-Hwue Kim7Tae-Jin Yun8Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaDivision of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaDivision of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaDivision of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaDivision of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaDivision of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaDivision of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaDivision of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaDivision of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaBackground: Since both the risk of death and the probability of spontaneous functional recovery (FR) coexist in association with pediatric dilated cardiomyopathy (DCMP), management should be based on individualized outcome predictions.Methods: A single-center retrospective review of 105 pediatric patients (age at presentation ≤ 18 years) with DCMP, managed between 1994 and 2017, was performed. Logistic regression was conducted to identify variables associated with FR and cardiac events (CEs), i.e., death or heart transplantation (HTPL), within 2 years after initial presentation. Two outcome prediction models were formulated using these variables.Results: Twenty-six (24.8%) and 51 patients (48.6%) experienced FR and CE, respectively, within 2 years after initial presentation. Predictors of mortality without HTPL were earlier era at presentation (HR: 4.13; 95% CI: 1.88–9.06; p < 0.001) and significant TR (≥moderate; HR: 4.31; 95% CI: 1.26–14.77; p = 0.020) in multivariable Cox regression model. Predictors of FR were recent era (HR: 4.49; 95% CI: 1.40–14.44; p = 0.0012), younger age at initial presentation (HR: 0.98 per 1 month increase; 95% CI: 0.97–0.99, p < 0.001), post-myocarditis DCMP (HR: 4.29; 95% CI: 1.32–13.93; p = 0.015), and arrhythmia-mediated DCMP (HR: 26.88; 95% CI: 2.61–276.70; p = 0.006). Risk factors for CEs was idiopathic DCMP (HR: 2.95; 95% CI: 1.32–6.56, p = 0.008). The low-risk group who had higher probability of FR than CE in prediction model had a slightly higher overall survival rate (71.4 vs. 52.2% at 10 years after presentation; log-rank p = 0.09) and a significantly higher HTPL-free survival rate (67.5 vs. 24.9% at 10 years after presentation; log-rank p < 0.001) than the high-risk group.Conclusions: Prognostication and management strategies for pediatric DCMP may be enhanced by risk stratification using outcome prediction modeling.https://www.frontiersin.org/articles/10.3389/fped.2021.736872/fullpediatric dilated cardiomyopathysuvivalfunctional recoveryheart transplantationcardiac eventmyocarditis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Dong-Hee Kim Eun Seok Choi Bo Sang Kwon Chun Soo Park Seul Gi Cha Jae Suk Baek Jeong Jin Yu Young-Hwue Kim Tae-Jin Yun |
spellingShingle |
Dong-Hee Kim Eun Seok Choi Bo Sang Kwon Chun Soo Park Seul Gi Cha Jae Suk Baek Jeong Jin Yu Young-Hwue Kim Tae-Jin Yun Development of Cardiac Events and Functional Recovery Prediction Models for Pediatric Dilated Cardiomyopathy Frontiers in Pediatrics pediatric dilated cardiomyopathy suvival functional recovery heart transplantation cardiac event myocarditis |
author_facet |
Dong-Hee Kim Eun Seok Choi Bo Sang Kwon Chun Soo Park Seul Gi Cha Jae Suk Baek Jeong Jin Yu Young-Hwue Kim Tae-Jin Yun |
author_sort |
Dong-Hee Kim |
title |
Development of Cardiac Events and Functional Recovery Prediction Models for Pediatric Dilated Cardiomyopathy |
title_short |
Development of Cardiac Events and Functional Recovery Prediction Models for Pediatric Dilated Cardiomyopathy |
title_full |
Development of Cardiac Events and Functional Recovery Prediction Models for Pediatric Dilated Cardiomyopathy |
title_fullStr |
Development of Cardiac Events and Functional Recovery Prediction Models for Pediatric Dilated Cardiomyopathy |
title_full_unstemmed |
Development of Cardiac Events and Functional Recovery Prediction Models for Pediatric Dilated Cardiomyopathy |
title_sort |
development of cardiac events and functional recovery prediction models for pediatric dilated cardiomyopathy |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Pediatrics |
issn |
2296-2360 |
publishDate |
2021-08-01 |
description |
Background: Since both the risk of death and the probability of spontaneous functional recovery (FR) coexist in association with pediatric dilated cardiomyopathy (DCMP), management should be based on individualized outcome predictions.Methods: A single-center retrospective review of 105 pediatric patients (age at presentation ≤ 18 years) with DCMP, managed between 1994 and 2017, was performed. Logistic regression was conducted to identify variables associated with FR and cardiac events (CEs), i.e., death or heart transplantation (HTPL), within 2 years after initial presentation. Two outcome prediction models were formulated using these variables.Results: Twenty-six (24.8%) and 51 patients (48.6%) experienced FR and CE, respectively, within 2 years after initial presentation. Predictors of mortality without HTPL were earlier era at presentation (HR: 4.13; 95% CI: 1.88–9.06; p < 0.001) and significant TR (≥moderate; HR: 4.31; 95% CI: 1.26–14.77; p = 0.020) in multivariable Cox regression model. Predictors of FR were recent era (HR: 4.49; 95% CI: 1.40–14.44; p = 0.0012), younger age at initial presentation (HR: 0.98 per 1 month increase; 95% CI: 0.97–0.99, p < 0.001), post-myocarditis DCMP (HR: 4.29; 95% CI: 1.32–13.93; p = 0.015), and arrhythmia-mediated DCMP (HR: 26.88; 95% CI: 2.61–276.70; p = 0.006). Risk factors for CEs was idiopathic DCMP (HR: 2.95; 95% CI: 1.32–6.56, p = 0.008). The low-risk group who had higher probability of FR than CE in prediction model had a slightly higher overall survival rate (71.4 vs. 52.2% at 10 years after presentation; log-rank p = 0.09) and a significantly higher HTPL-free survival rate (67.5 vs. 24.9% at 10 years after presentation; log-rank p < 0.001) than the high-risk group.Conclusions: Prognostication and management strategies for pediatric DCMP may be enhanced by risk stratification using outcome prediction modeling. |
topic |
pediatric dilated cardiomyopathy suvival functional recovery heart transplantation cardiac event myocarditis |
url |
https://www.frontiersin.org/articles/10.3389/fped.2021.736872/full |
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