1
|
Elzayat RS, Bahbah WA, Elzaiat RS, Elgazzar BA. Fibroblast growth factor 23 in children with or without heart failure: a prospective study. BMJ Paediatr Open 2023; 7:e001753. [PMID: 36828640 PMCID: PMC9972412 DOI: 10.1136/bmjpo-2022-001753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/01/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Elevated fibroblast growth factor 23 (FGF23) levels have been associated with mortality in adults with heart failure (HF), but data on FGF23 levels in paediatric HF are limited. In this prospective cohort study, we aimed to assess the prognostic value of FGF23 in children with chronic HF. METHODS We prospectively enrolled 40 children with chronic HF and 20 matched healthy controls. In each patient, a complete diagnostic workup was performed, including transthoracic echocardiography to evaluate cardiac systolic and diastolic functions. Serum FGF23, renal function tests, parathyroid hormone, serum calcium and phosphate were measured in patients and controls. N-terminal probrain natriuretic peptide (NT-proBNP) was measured in patients. The severity of symptoms was assessed using the modified Ross HF classification for children. Patients were followed for 1 year, and clinical worsening events such as death and HF hospitalisation were recorded. RESULTS Patients with HF had significantly higher FGF23 levels compared with controls (355.68±97.27 pg/mL and 60.20±11.04 pg/mL, respectively; p<0.001). Three patients died and 11 were admitted with HF. In comparison with patients without clinical worsening events, these 14 patients exhibited significantly higher FGF23 levels (320.04±89.56 pg/mL and 421.86±75.50 pg/mL, respectively; p<0.001). FGF23 was positively correlated with NT-proBNP and left ventricular end-diastolic diameter and negatively correlated with ejection fraction and fractional shortening. The ability of FGF23 to predict clinical worsening events in patients was analysed using a receiver operating characteristic curve. The optimal cut-off point was 375 pg/mL, with 85.71% sensitivity, 84.62% specificity, positive predictive value of 75.0, negative predictive value of 91.7 and area under the curve (AUC) of 0.878. Multivariable regression analysis revealed that FGF23 is the only independent predictor of clinical worsening events in children with chronic HF. CONCLUSION FGF23 levels were elevated in children with chronic HF and increased significantly as Ross score class increased. FGF23 levels increased in patients who experienced clinical worsening events.
Collapse
Affiliation(s)
| | - Wael Abbas Bahbah
- Pediatrics, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt
| | - Reham Salah Elzaiat
- Clinical Pathology, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt
| | | |
Collapse
|
2
|
Adorisio R, Cantarutti N, Ciabattini M, Amodeo A, Drago F. Real-World Use of Carvedilol in Children With Dilated Cardiomyopathy: Long-Term Effect on Survival and Ventricular Function. Front Pediatr 2022; 10:845406. [PMID: 35433536 PMCID: PMC9010785 DOI: 10.3389/fped.2022.845406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Carvedilol is recommended for chronic heart failure (HF) treatment in children. However, the ideal dosage and administration are not standardized, and data on its long-term effects are lacking. This study aimed to assess the effect of a high dosage regimen of carvedilol on cardiac outcomes in children with HF. METHODS We conducted a retrospective cohort study including all children with HF and dilated cardiomyopathy. We analyzed medical records before starting treatment, at 1 and 3 years after reaching the maximum therapeutic dosage. All data were compared with a historical control group. Kaplan-Meier analysis and Cox proportional hazard regression have been used to evaluate the effect of high dosage carvedilol therapy. The main outcome was a composite of all-cause mortality and heart transplant. RESULTS One hundred thirty-five were included in the study and 65 treated with a high dosage of carvedilol regimen (up to 1 mg/kg/day). Heart rate reduction (mean reduction 30%, p < 0.0001) and ejection fraction improvement (32 ± 9.4 vs. 45. ± 10.1%, p < 0.0001) were statistically significant in those. Long-term survival and freedom from heart transplant were significantly improved in those treated with high dosage carvedilol therapy (p = 0.00001). CONCLUSIONS Treatment with the high dosage of carvedilol, in addition to standard HF therapy, significantly improves ventricular function and survival in children with dilated cardiomyopathy and chronic HF.
Collapse
Affiliation(s)
- Rachele Adorisio
- Advanced Cardiovascular Therapies, Department of Cardiology, Cardiac Surgery, Heart and Lung Transplant, Bambino Gesù Children Hospital and Research Institute, Rome, Italy
| | - Nicoletta Cantarutti
- Pediatric Cardiology and Arrhythmias/Syncope Units, Department of Cardiology, Cardiac Surgery, Heart and Lung Transplant, Bambino Gesù Children Hospital and Research Institute, Rome, Italy
| | - Marco Ciabattini
- Clinical Trial Center, University Department of Pediatrics, Bambino Gesù Children Hospital and Research Institute, Rome, Italy
| | - Antonio Amodeo
- Advanced Cardiovascular Therapies, Department of Cardiology, Cardiac Surgery, Heart and Lung Transplant, Bambino Gesù Children Hospital and Research Institute, Rome, Italy
| | - Fabrizio Drago
- Pediatric Cardiology and Arrhythmias/Syncope Units, Department of Cardiology, Cardiac Surgery, Heart and Lung Transplant, Bambino Gesù Children Hospital and Research Institute, Rome, Italy
| |
Collapse
|
3
|
Mori H, Yoshikawa T, Kimura H, Ono H, Kato H, Ono Y, Nii M, Shindo T, Inuzuka R, Horigome H, Miura M, Ogawa S, Shiono J, Furutani Y, Ishido M, Nakanishi T. Outcomes of Dilated Cardiomyopathy in Japanese Children - A Retrospective Cohort Study. Circ J 2021; 86:109-115. [PMID: 34588404 DOI: 10.1253/circj.cj-20-1239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There has been no nationwide survey on the prognosis of pediatric dilated cardiomyopathy (DCM) in Japan. Therefore, we designed this retrospective multicenter study to investigate the long-term survival rate in pediatric patients with DCM in Japan.Methods and Results:In this multicenter retrospective observational study, data were reviewed for 106 patients aged <18 years who had been diagnosed with DCM at any 1 of 18 Japanese institutions between 1990 and 2014. The median age at diagnosis was 2.0 years and the median duration of observation was 3.3 years. Most DCM patients were diagnosed because of symptoms of heart failure. On echocardiography, the median left ventricular end-diastolic dimension z score was 5.4 and fractional shortening was 0.10. Freedom from death or transplantation rates at 1, 3, 5, 10, and 20 years after diagnosis were 76%, 66%, 64%, 58%, and 43%, respectively. Freedom from death rates at 1, 5, 10, and 20 years after diagnosis were 81%, 75%, 72%, and 53%, respectively. The incidence of heart transplantation at 1, 5, 10, and 20 years after diagnosis was 6%, 15%, 20%, and 20%, respectively, suggesting that only 15% of patients in Japan underwent heart transplantation within 5 years of diagnosis. CONCLUSIONS In Japan, the prognosis of pediatric DCM is poor and the rate of heart transplantation is low.
Collapse
Affiliation(s)
- Hiroki Mori
- Department of Pediatric Cardiology, Tokyo Women's Medical University
| | | | - Hitomi Kimura
- Division of Pediatric Cardiology, Sakakibara Heart Institute
| | - Hiroshi Ono
- Division of Cardiology, National Center for Child Health and Development
| | - Hitoshi Kato
- Division of Cardiology, National Center for Child Health and Development
| | - Yasuo Ono
- Division of Cardiology, Shizuoka Children's Hospital
| | - Masaki Nii
- Division of Cardiology, Shizuoka Children's Hospital
| | | | | | | | - Masaru Miura
- Division of Cardiology, Tokyo Metropolitan Children's Medical Center
| | | | - Junko Shiono
- Division of Cardiology, Ibaraki Children's Hospital
| | | | - Mikiko Ishido
- Department of Pediatric Cardiology, Tokyo Women's Medical University
| | - Toshio Nakanishi
- Department of Pediatric Cardiology, Tokyo Women's Medical University.,Department of Pediatrics, International University of Health and Welfare, School of Medicine, Narita Hospital
| |
Collapse
|
4
|
Pezzoli L, Pezzani L, Bonanomi E, Marrone C, Scatigno A, Cereda A, Bedeschi MF, Selicorni A, Gasperini S, Bini P, Maitz S, Maccioni C, Pedron C, Colombo L, Marchetti D, Bellini M, Lincesso AR, Perego L, Pingue M, Della Malva N, Mangili G, Ferrazzi P, Iascone M. Not Only Diagnostic Yield: Whole-Exome Sequencing in Infantile Cardiomyopathies Impacts on Clinical and Family Management. J Cardiovasc Dev Dis 2021; 9:jcdd9010002. [PMID: 35050212 PMCID: PMC8780486 DOI: 10.3390/jcdd9010002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 12/26/2022] Open
Abstract
Whole-exome sequencing (WES) is a powerful and comprehensive tool for the genetic diagnosis of rare diseases, but few reports describe its timely application and clinical impact on infantile cardiomyopathies (CM). We conducted a retrospective analysis of patients with infantile CMs who had trio (proband and parents)-WES to determine whether results contributed to clinical management in urgent and non-urgent settings. Twenty-nine out of 42 enrolled patients (69.0%) received a definitive molecular diagnosis. The mean time-to-diagnosis was 9.7 days in urgent settings, and 17 out of 24 patients (70.8%) obtained an etiological classification. In non-urgent settings, the mean time-to-diagnosis was 225 days, and 12 out of 18 patients (66.7%) had a molecular diagnosis. In 37 out of 42 patients (88.1%), the genetic findings contributed to clinical management, including heart transplantation, palliative care, or medical treatment, independent of the patient’s critical condition. All 29 patients and families with a definitive diagnosis received specific counseling about recurrence risk, and in seven (24.1%) cases, the result facilitated diagnosis in parents or siblings. In conclusion, genetic diagnosis significantly contributes to patients’ clinical and family management, and trio-WES should be performed promptly to be an essential part of care in infantile cardiomyopathy, maximizing its clinical utility.
Collapse
Affiliation(s)
- Laura Pezzoli
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
| | - Lidia Pezzani
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
- Pediatria ad Alta Intensità di Cura, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Ezio Bonanomi
- Terapia Intensiva Pediatrica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Chiara Marrone
- Cardiologia Pediatrica, Fondazione G. Monasterio, 54100 Massa, Italy;
| | - Agnese Scatigno
- Pediatria, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (A.S.); (A.C.)
| | - Anna Cereda
- Pediatria, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (A.S.); (A.C.)
| | - Maria Francesca Bedeschi
- Genetica Medica, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy;
| | | | - Serena Gasperini
- Malattie Metaboliche Rare, Dipartimento di Pediatria, Fondazione MBBM, ASST, 20900 Monza, Italy;
| | - Paolo Bini
- Terapia Intensiva Neonatale, ASST Lariana, 22100 Como, Italy;
| | - Silvia Maitz
- Ambulatorio di Genetica Pediatrica, Clinica Pediatrica, Fondazione MBBM, Ospedale S. Gerardo, 20900 Monza, Italy;
| | - Carla Maccioni
- Terapia Intensiva Neonatale, Ospedale A. Manzoni, ASST, 23900 Lecco, Italy;
| | - Cristina Pedron
- Cardiologia, Ospedale di Bolzano, Azienda Sanitaria dell’Alto Adige, 39100 Bolzano, Italy;
| | - Lorenzo Colombo
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy;
| | - Daniela Marchetti
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
| | - Matteo Bellini
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
| | - Anna Rita Lincesso
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
| | - Loredana Perego
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
| | - Monica Pingue
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
| | - Nunzia Della Malva
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
| | - Giovanna Mangili
- Patologia Neonatale, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Paolo Ferrazzi
- Centro Cardiomiopatia Ipertrofica, Policlinico di Monza, 20900 Monza, Italy;
| | - Maria Iascone
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
- Correspondence: ; Tel.: +39-0352678112
| |
Collapse
|
5
|
Miric D, Barac A, Capkun V, Bakovic D. Right ventricular free wall strain in acutely decompensated heart failure patients with ischemic and non-ischemic cardiomyopathy. Echocardiography 2021; 38:1747-1753. [PMID: 34555211 DOI: 10.1111/echo.15205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/09/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS Right ventricular (RV) dysfunction is a predictor of adverse outcomes among patients with HF with reduced ejection fraction (HFrEF); however, differences in RV parameters in HFrEF patients with ischemic (ICM) and non-ischemic cardiomyopathies (NICM) are not well understood. We investigated echocardiographic characteristics, including RV strain, in patients with acute decompensated heart failure (ADHF) and compared patients with ICM and NICM etiology. METHODS Consecutive patients who presented with ADHF and NYHA class III-IV were prospectively enrolled if they had LVEF < 40% and history of ICM or NICM. All patients underwent clinical exam, laboratory evaluation and 2-D echocardiographic assessment of the left ventricular (LV) and RV function, LV and RV global longitudinal strain (LVGLS, RVGLS), and RV free wall strain (RVfwLS). RESULTS Of 84 patients, 44 had ICM and 40 NICM. The groups had similar blood pressure, NT-proBNP, and echocardiographic parameters of LV function including LVGLS. Absolute RVGLS values were lower than RVfwLS values in both groups. Patients with NICM had significantly lower RVfwLS, but not RVGLS, compared to patients with ICM (-13% to -17%, p = 0.006). Similar differences in RVfwLS were seen in patients in NYHA class III (NICM vs ICM: -13% and -17%, respectively, 95% CI: -8.5 to -.5) and NYHA class IV (NICM vs ICM: -13.8% and -17%, respectively, 95% CI: -6.4 to -.59). CONCLUSION Among patients hospitalized with ADHF, patients with nonischemic etiology compared with the patients with ICM, have more severe RV dysfunction measured by RVfwLS, despite similar extent of LV impairment and the same functional limitation class.
Collapse
Affiliation(s)
- Dino Miric
- Department of Cardiovascular Diseases, Division of Heart Failure, University Hospital Split, Split, Croatia
| | - Ana Barac
- MedStar Heart and Vascular Institute, Georgetown University, Washington DC, USA
| | - Vesna Capkun
- Department of Nuclear Medicine, University Hospital Split, Split, Croatia.,University of Split School of Medicine, Split, Croatia
| | - Darija Bakovic
- Department of Cardiovascular Diseases, Division of Heart Failure, University Hospital Split, Split, Croatia.,University of Split School of Medicine, Split, Croatia
| |
Collapse
|
6
|
Speicher MV, Lim DM, Field AG, Childers RC. An Unusual Case of Neonatal High-Output Heart Failure: Infantile Hepatic Hemangioma. J Emerg Med 2020; 60:107-111. [PMID: 33160823 DOI: 10.1016/j.jemermed.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/09/2020] [Accepted: 10/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Infantile hepatic hemangioma (IHH) is a rare but life-threatening disorder that must be considered in the newborn presenting with high-output heart failure (HF). IHH is a tumor comprised of large vascular beds, which require a significant increase in blood flow as the lesion grows. This, in turn, creates an undue burden on the cardiovascular system, leading to high-output HF and potentially, respiratory distress. Recent changes have been made in the classification of certain hepatic hemangiomas and their treatments. CASE REPORT A 10-day-old girl presented to the Emergency Department with increased respiratory effort and an episode of apnea and cyanosis. A chest x-ray study was obtained and showed cardiomegaly and pulmonary edema concerning for HF. The patient was promptly admitted to the pediatric intensive care unit, where advanced imaging was obtained revealing findings consistent with IHH. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: HF in an infant is a critical condition often requiring prompt intervention and rapid diagnosis of the correct etiology to save a life. IHH is an example of an extrathoracic etiology of pediatric HF that has undergone recent changes in terminology and diagnosis. Increased awareness among emergency physicians of this disease process and its treatments can lead to expeditious diagnosis and treatment of this potentially life-threatening illness.
Collapse
Affiliation(s)
| | - David M Lim
- Emergency Department, Naval Medical Center San Diego, San Diego, California
| | - Adam G Field
- Emergency Department, Naval Medical Center San Diego, San Diego, California
| | - Richard C Childers
- Emergency Department, Naval Medical Center San Diego, San Diego, California
| |
Collapse
|
7
|
Bottinor WJ, Friedman DL, Ryan TD, Wang L, Yu C, Borinstein SC, Godown J. Cardiovascular disease and asymptomatic childhood cancer survivors: Current clinical practice. Cancer Med 2020; 9:5500-5508. [PMID: 32558321 PMCID: PMC7402829 DOI: 10.1002/cam4.3190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/19/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND It is poorly understood how cardiovascular screening in asymptomatic childhood cancer survivors (CCS) is applied to and impacts clinical care. OBJECTIVES To describe the current role of cardiovascular screening in the clinical care of asymptomatic CCS. METHODS At 50 pediatric academic medical centers, a childhood cancer survivorship clinic director, pediatric cardiologist, and adult cardiologist with a focus on CCS were identified and invited to participate in a survey. Surveys were managed electronically. Categorical data were analyzed using nonparametric methods. RESULTS Of the 95 (63%) respondents, 39% were survivorship practitioners, and 61% were cardiologists. Eighty-eight percent of survivorship practitioners reported that greater than half of CCS received cardiovascular screening. CCS followed by adult cardiology were more likely to be seen by a cardio-oncologist. Those followed by pediatric cardiology were more likely to be seen by a heart failure/transplant specialist. Common reasons for referral to cardiology were abnormal cardiovascular imaging or concerns a CCS was at high risk for cardiovascular disease. Ninety-two percent of cardiologists initiated angiotensin converting enzyme inhibitor or angiotensin receptor blocker therapy for mild systolic dysfunction. Adult cardiologists initiated beta-blocker therapy for less severe systolic dysfunction compared to pediatric cardiologists (P < .001). Pediatric cardiologists initiated mineralocorticoid therapy for less severe systolic dysfunction compared to adult cardiologists (P = .025). Practitioners (93%) support a multi-institutional collaboration to standardize cardiovascular care for CCS. CONCLUSIONS While there is much common ground in the clinical approach to CCS, heterogeneity is evident. This highlights the need for cohesive, multi-institutional, standardized approaches to cardiovascular management in CCS.
Collapse
Affiliation(s)
- Wendy J Bottinor
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Debra L Friedman
- Department of Pediatrics, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas D Ryan
- Department of Pediatrics, University of Cincinnati College of Medicine; Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Li Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chang Yu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott C Borinstein
- Department of Pediatrics, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Justin Godown
- Department of Pediatrics, Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
8
|
Abstract
Pediatric heart failure (PHF) is an important cause of mortality and morbidity. Whereas ischemic heart disease is the most important cause of heart failure in adults, congenital heart diseases (CHD) and cardiomyopathies are important etiologies of PHF. Management of PHF also differs from that of adults. Here authors have reviewed the literature on PHF with respect to etiology, symptoms, investigations and treatment strategies.
Collapse
Affiliation(s)
- Manojkumar Rohit
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Sudhansu Budakoty
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| |
Collapse
|
9
|
Morell E, Moynihan K, Wolfe J, Blume ED. Palliative care and paediatric cardiology: current evidence and future directions. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:502-510. [PMID: 31126897 DOI: 10.1016/s2352-4642(19)30121-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/20/2019] [Accepted: 02/27/2019] [Indexed: 12/24/2022]
Abstract
Although outcomes for children with heart disease have improved substantially over the past several decades, heart disease remains one of the leading causes of paediatric mortality. For children who progress to advanced heart disease, disease morbidity is high, with many children requiring multiple surgical interventions and long-term intensive care hospitalisations. Care for children with advanced heart disease requires a multidisciplinary approach, and opportunities for earlier integration of palliative care are being explored. This Viewpoint summarises the relevant literature over the past decade. We also identify gaps in parent and provider understanding of prognosis and communication, propose indications for palliative care consultation in paediatric advanced heart disease, and summarise attitudes and perceived barriers to palliative care consultation. Areas for additional research that we identify include paediatric cardiologist education, parental distress, socioeconomic disparities, and patient-reported outcomes. Interdisciplinary clinical and research efforts are required to further advance the field and improve integration of palliative care in the care of children with heart disease.
Collapse
Affiliation(s)
- Emily Morell
- Division of Pediatric Critical Care, UCSF Benioff Children's Hospitals, San Francisco, CA, USA
| | - Katie Moynihan
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Joanne Wolfe
- Pediatric Palliative Care, Boston Children's Hospital, Boston, MA, USA
| | - Elizabeth D Blume
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
| |
Collapse
|
10
|
Missed Diagnosis of New-Onset Systolic Heart Failure at First Presentation in Children with No Known Heart Disease. J Pediatr 2019; 208:258-264.e3. [PMID: 30679055 DOI: 10.1016/j.jpeds.2018.12.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine frequency of missed heart failure diagnosis at first presentation among children with no known heart disease admitted with new-onset heart failure. STUDY DESIGN Using a retrospective design, we reviewed electronic medical records of all patients aged <21 years with no known heart disease, hospitalized with new-onset heart failure during 2003-2015 at a tertiary-quaternary care institution. We assessed records for missed diagnosis of heart failure (primary outcome), associated process breakdowns, and clinical outcomes using a structured data collection instrument. RESULTS Of 191 patients meeting inclusion criteria, 49% (94/191) were missed on first presentation. Most common incorrect diagnostic labels given to "missed" patients were bacterial infection (29%; 27/94), followed by viral illness (22%; 21/94) and gastroenteritis/hepatitis (21%; 20/94). On multivariable analysis, presentation to primary care provider (PCP), longer duration of symptoms (median 7 days), more than 2 symptoms of heart failure, and nausea/emesis were associated with missed diagnosis. On examining process breakdowns, 49% had errors in history-taking and 50% had no documentation of differential diagnoses. There was no difference in hospital mortality, length of stay, or mechanical circulatory support in missed vs not-missed cohorts. Unnecessary noninvasive and invasive tests were performed in 18% and 4% of patients, respectively. CONCLUSIONS Nearly one-half of children with no known heart disease hospitalized with systolic heart failure were missed at first presentation and underwent significant nonrelevant treatment and testing. Initial presentation to the PCP, longer duration of symptoms before presentation, and nausea/emesis were associated with missed diagnosis.
Collapse
|
11
|
Dong A, Zhang X, Zhou H, Chen S, Zhao W, Wu M, Guo J, Guo W. Applicability and cross-cultural validation of the Chinese version of the Warwick-Edinburgh mental well-being scale in patients with chronic heart failure. Health Qual Life Outcomes 2019; 17:55. [PMID: 30922342 PMCID: PMC6440095 DOI: 10.1186/s12955-019-1120-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 03/13/2019] [Indexed: 12/02/2022] Open
Abstract
Background The mental well-being of patients with chronic heart failure is likely to influence their health-related quality of life and decrease the utilization of public health resources. This study assessed the mental well-being of patients with chronic heart failure and evaluated the reliability and validity of the Warwick-Edinburgh Mental Well-Being Scale. Methods We conducted a cross-sectional survey from July 2016 to July 2017 among 191 patients with chronic heart failure, and examined psychometric properties of the Warwick-Edinburgh Mental Well-Being Scale, such as internal consistency, reliability, test-retest reliability, and factorial validity of the Chinese version of the Warwick-Edinburgh Mental Well-Being Scale. Results One-dimensional construct validity was demonstrated by confirmatory factor analysis. The psychometric properties of the Chinese version of the Warwick-Edinburgh Mental Well-Being Scale were satisfactory in our sample of patients with chronic heart failure. The internal consistency reliability was .948 and the test-retest reliability .925. The item-total correlations ranged from .405 to .872. There was a strong correlation (r = .79) between the Chinese version of the Warwick-Edinburgh Mental Well-Being Scale and the five-item World Health Organization Well-Being Index. The Chinese version of the Warwick-Edinburgh Mental Well-Being Scale appears acceptable for use in patients with chronic heart failure, and we were able to verify its reliability and validity with our sample. Conclusions The Chinese version of the Warwick-Edinburgh Mental Well-Being Scale is a reliable quantitative tool for evaluating mental well-being in patients with chronic heart failure in clinical settings, and this has important implications for overall assessments of mental well-being in patients with chronic heart failure. Electronic supplementary material The online version of this article (10.1186/s12955-019-1120-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Aishu Dong
- Emergency Department, the Second Affiliated Hospital of Wenzhou Medical University, College West Road 109, 0577, Wenzhou, Zhejiang, People's Republic of China
| | - Xiuxia Zhang
- Emergency Department, the Second Affiliated Hospital of Wenzhou Medical University, College West Road 109, 0577, Wenzhou, Zhejiang, People's Republic of China
| | - Haitao Zhou
- Cardiac Department, the Second Affiliated Hospital of Wenzhou Medical University, College West Road 109, 0577, Wenzhou, Zhejiang, People's Republic of China
| | - Siyi Chen
- Cardiac Department, the Second Affiliated Hospital of Wenzhou Medical University, College West Road 109, 0577, Wenzhou, Zhejiang, People's Republic of China
| | - Wei Zhao
- Cardiac Department, the Second Affiliated Hospital of Wenzhou Medical University, College West Road 109, 0577, Wenzhou, Zhejiang, People's Republic of China
| | - Minmin Wu
- Cardiac Department, the Second Affiliated Hospital of Wenzhou Medical University, College West Road 109, 0577, Wenzhou, Zhejiang, People's Republic of China
| | - Junyi Guo
- Chemoradiotherapy Department, the Second Affiliated Hospital of Wenzhou Medical University, College West Road 109, 0577, Wenzhou, Zhejiang, People's Republic of China
| | - Wenjian Guo
- Hematology Department, the Second Affiliated Hospital of Wenzhou Medical University, College West Road 109, 0577, Wenzhou, Zhejiang, People's Republic of China.
| |
Collapse
|
12
|
Recher M, Botte A, Baudelet JB, Leteurtre S, Godart F. Évaluation de la fonction diastolique du ventricule gauche en réanimation pédiatrique : quelles indications, quels paramètres mesurer ? MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2019-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’incidence des patients avec une insuffisance cardiaque diastolique a augmenté au cours des dernières années. De nombreuses études épidémiologiques, physiopathologiques, cliniques ou pronostiques ont été menées pour comprendre cette nouvelle entité. L’étude et l’analyse de la fonction diastolique (FD) sont devenues des temps essentiels de l’examen échocardiographique. Cet article a pour objectifs : 1) de faire le point sur la physiologie de la FD du ventricule gauche (VG) et sur son évaluation chez l’enfant ; 2) d’envisager des applications cliniques en réanimation pédiatrique pour lesquelles son évaluation est importante. L’évaluation de la FD du VG est complexe, en plein essor et encore peu réalisée en pédiatrie. De plus, la tachycardie chez l’enfant et les particularités pédiatriques encore méconnues rendent difficile l’analyse de certains paramètres. L’ETT est l’examen complémentaire incontournable pour évaluer la FD du VG, mais en cours d’étude chez l’enfant. L’évaluation de la FD du VG devrait faire partie intégrante des paramètres échocardiographiques à prendre en considération pour certaines situations (évaluation de la réponse au remplissage vasculaire et de la sevrabilité à la ventilation mécanique, ajustement des traitements…) afin de mieux comprendre sa mesure et l’utiliser en routine clinique. On retiendra que pour l’évaluation échocardiographique chez l’enfant de réanimation : dans un premier temps évaluer la fonction systolique puis s’efforcer d’évaluer l’évolution de la FD par les pressions de remplissage par des paramètres simples (doppler mitral et tissulaire) ajustés au Z-score (urihttp://www.parameterz.comhttp://www.parameterz.com) tels que les rapports E/e’ et E/A, le volume indexé de l’OG, le tout assorti au contexte clinique et à la cinétique des paramètres biologiques (BNP, NT pro-BNP).
Collapse
|
13
|
Abstract
Congestive heart failure is a final common clinical pathway for several diseases in childhood, such as familial cardiomyopathy, viral myocarditis, inborn errors of metabolism, and autoimmune disorders. Early identification and treatment can reduce symptom severity and may affect outcomes. In this review, the clinical characteristics of pediatric heart failure are described, and the initial diagnostic evaluation is outlined. Evidence-based heart failure treatment strategies at various clinical stages are discussed in detail, including the management of acute decompensated heart failure.
Collapse
Affiliation(s)
- Jack F Price
- Department of Pediatrics, Baylor College of Medicine, and Advanced Heart Failure Unit, Texas Children's Hospital, Houston, TX
| |
Collapse
|
14
|
Abstract
The Prospective comparison of angiotensin receptor antagonist Valsartan and neprilysin inhibitor Sacubitril with angiotensin-converting enzyme inhibitor (enalapril) to determine impact on Global Mortality and Morbidity in Heart Failure trial has demonstrated that Sacubitril/Valsartan is superior to Enalapril in reducing the risks of both sudden cardiac death and death from worsening heart failure. This novel combination, Sacubitril/Valsartan, is also shown to reduce the risk of hospitalisation and progression of heart failure in adults. However, the benefit of Sacubitril/Valsartan in paediatric heart failure patients is unknown. In this review, we discuss the similarities and differences in pathophysiology of heart failure in children versus adults, and the potential role of Sacubitril/Valsartan in paediatric heart failure patients.
Collapse
|
15
|
Hill AC, Silka MJ, Bar-Cohen Y. Cardiac Resynchronization Therapy in Pediatrics. J Innov Card Rhythm Manag 2018; 9:3256-3264. [PMID: 32477817 PMCID: PMC7252792 DOI: 10.19102/icrm.2018.090804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/27/2017] [Indexed: 12/24/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) has proven to be a powerful and effective tool in the treatment of adults with severe dilated or ischemic cardiomyopathy. A substantial portion of the adult heart failure population has severely depressed systolic function, heart failure symptoms, QRS prolongation, and left bundle branch block. Indications for CRT in adults are commonly focused on these characteristics. However, pediatric patients represent a heterogeneous group with many etiologies of heart failure and anatomic variants, with most of them not fitting the typical adult CRT criteria. The heterogeneity of the pediatric population has hindered the identification of ideal candidates for CRT, but initial experience with CRT in various groups of pediatric patients has been encouraging. This article reviews indications for and outcomes of CRT in pediatric and congenital heart disease patients.
Collapse
Affiliation(s)
- Allison C Hill
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael J Silka
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yaniv Bar-Cohen
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
16
|
Cassalett-Bustillo G. Falla cardíaca en pacientes pediátricos. Fisiopatología y manejo. Parte I. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
17
|
Das BB. Current State of Pediatric Heart Failure. CHILDREN-BASEL 2018; 5:children5070088. [PMID: 29958420 PMCID: PMC6069285 DOI: 10.3390/children5070088] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/23/2018] [Accepted: 06/26/2018] [Indexed: 12/11/2022]
Abstract
Pediatric heart failure (HF) represents an important cause of morbidity and mortality in childhood. There is an overlapping relationship of HF, congenital heart disease, and cardiomyopathy. The goal of treatment of HF in children is to maintain stability, prevent progression, and provide a reasonable milieu to allow somatic growth and optimal development. Current management and therapy for HF in children are extrapolated from treatment approaches in adults. There are significant barriers in applying adult data to children because of developmental factors, age variation from birth to adolescence, and differences in the genetic expression profile and β-adrenergic signaling. At the same time, there are significant challenges in performing well-designed drug trials in children with HF because of heterogeneity of diagnoses identifying a clinically relevant outcome with a high event rate, and a difficulty in achieving sufficient enrollment. A judicious balance between extrapolation from adult HF guidelines and the development of child-specific data on treatment represent a wise approach to optimize pediatric HF management. This approach is helpful as reflected by the increasing role of ventricular assist devices in the management of advanced HF in children. This review discusses the causes, epidemiology, pathophysiology, clinical manifestations, conventional medical treatment, clinical trials, and the role of device therapy in pediatric HF.
Collapse
Affiliation(s)
- Bibhuti B Das
- Joe DiMaggio Children's Heart Institute, Memorial Health Care System, Hollywood, FL 33021, USA.
| |
Collapse
|
18
|
Park CS, Villa CR, Lorts A, Chin C, Tweddell JS, Zafar F, Morales DLS. Is there an optimal organ acceptance rate for pediatric heart transplantation: "A sweet spot"? Pediatr Transplant 2018; 22:e13149. [PMID: 29380475 DOI: 10.1111/petr.13149] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2017] [Indexed: 11/30/2022]
Abstract
Despite a limited supply of donors, potential donor hearts are often declined for subjective concerns regarding organ quality. This analysis will investigate the relationship between donor heart AR and patient outcome at pediatric transplant centers. The UNOS database was used to identify all match runs for pediatric candidates (age < 18 years) from 2008 through March 2015 in which a heart offer was ultimately placed. Centers which received ≥10 offers/y were included (10 634 offers, 38 centers). Transplant centers were stratified based on their AR: low (<20%, n = 13), medium (20%-40%, n = 16), or high (>40%, n = 9). Low AR centers experienced worse negative WL outcome compared with medium (P = .022) and high (P = .004) AR centers. Low AR centers had similar post-transplant graft survival to medium (P = .311) or high (P = .393) AR centers; however, medium AR centers had better post-transplant graft survival than high AR centers (P = .037). E-F survival from listing regardless of transplant was worse for low AR centers compared with medium (P < .001) or high (P = .001) AR centers. Low AR centers experience worse WL outcomes without improvement in post-transplant outcomes. High AR centers experience higher post-transplant graft failure than medium AR centers. AR of 20%-40% appears to have optimal WL and post-transplant outcomes.
Collapse
Affiliation(s)
- Chun Soo Park
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chet R Villa
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Angela Lorts
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Clifford Chin
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James S Tweddell
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Farhan Zafar
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David L S Morales
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
19
|
Urmaliya V, Franchelli G. A multidimensional sight on cardiac failure: uncovered from structural to molecular level. Heart Fail Rev 2018; 22:357-370. [PMID: 28474325 DOI: 10.1007/s10741-017-9610-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Heart failure is one of the leading causes of death, with high mortality rate within 5 years after diagnosis. Treatment and prognosis options for heart failure primarily targeted on hemodynamic and neurohumoral components that drive progressive deterioration of the heart. However, given the multifactorial background that eventually leads to the "phenotype" named heart failure, better insight into the various components may lead to personalized treatment opportunities. Indeed, currently used criteria to diagnose and/or classify heart failure are possibly too focused on phenotypic improvement rather than the molecular driver of the disease and could therefore be further refined by integrating the leap of molecular and cellular knowledge. The ambiguity of the ejection fraction-based classification criteria became evident with development of advanced molecular techniques and the dawn of omics disciplines which introduced the idea that disease is caused by a myriad of cellular and molecular processes rather than a single event or pathway. The fact that different signaling pathways may underlie similar clinical manifestations calls for a more holistic study of heart failure. In this context, the systems biology approach can offer a better understanding of how different components of a system are altered during disease and how they interact with each other, potentially leading to improved diagnosis and classification of this condition. This review is aimed at addressing heart failure through a multilayer approach that covers individually some of the anatomical, morphological, functional, and tissue aspects, with focus on cellular and subcellular features as an alternative insight into new therapeutic opportunities.
Collapse
Affiliation(s)
- Vijay Urmaliya
- Discovery Sciences, Janssen Research & Development, Beerse, Belgium.
| | | |
Collapse
|
20
|
Phelps CM, Stiver C, Heard T, Texter KM, Yates AR. Serial assessment of brain natriuretic peptide in single ventricle patients with a hybrid stage 1 palliation. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2017.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
21
|
Higgins D, Otero J, Jefferis Kirk C, Pak J, Jorgensen N, Kemna M, Albers E, Hong B, Friedland-Little J, Law Y. Iron Laboratory Studies in Pediatric Patients With Heart Failure from Dilated Cardiomyopathy. Am J Cardiol 2017; 120:2049-2055. [PMID: 28942941 DOI: 10.1016/j.amjcard.2017.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 12/12/2022]
Abstract
Iron deficiency (FeD), with or without anemia, in adults with heart failure (HF) is associated with poor outcomes, which can be improved with replacement therapy. A similar therapeutic opportunity may exist for children; however, iron laboratory measurements and FeD have not been described in pediatric patients with HF. A single-center, retrospective study was conducted on 28 patients <21 years old with a diagnosis of dilated cardiomyopathy and HF who had iron laboratories (serum iron, iron saturation, and ferritin) performed. The mean (standard deviation) age at time of laboratory collection was 10.3 (5.5) years. Twenty-seven patients (96.4%) met the criteria for FeD. Serum iron and iron saturation were significantly associated with inpatient hospitalization, being on inotropic medications, or having stage D HF. Low-serum iron was associated with a higher left ventricular end-diastolic dimension and left ventricular end-systolic dimension z-score by echocardiography ((β -2.58, 95% confidence interval [CI] -4.76, -0.40, p = 0.02) and (β -2.43, 95% CI -4.70, -0.17, p = 0.04)), respectively. Low ferritin was associated with higher mortality (relative risk 0.29, 95% CI 0.12, 0.70, p = 0.006). In conclusion, FeD was common in this pediatric cohort with more advanced HF. Iron profile abnormalities were associated with worse HF severity and outcomes including mortality.
Collapse
|
22
|
Shaddy R, Canter C, Halnon N, Kochilas L, Rossano J, Bonnet D, Bush C, Zhao Z, Kantor P, Burch M, Chen F. Design for the sacubitril/valsartan (LCZ696) compared with enalapril study of pediatric patients with heart failure due to systemic left ventricle systolic dysfunction (PANORAMA-HF study). Am Heart J 2017; 193:23-34. [PMID: 29129252 DOI: 10.1016/j.ahj.2017.07.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 07/12/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Sacubitril/valsartan (LCZ696) is an angiotensin receptor neprilysin inhibitor approved for the treatment of adult heart failure (HF); however, the benefit of sacubitril/valsartan in pediatric HF patients is unknown. STUDY DESIGN This global multi-center study will use an adaptive, seamless two-part design. Part 1 will assess the pharmacokinetics/pharmacodynamics of single ascending doses of sacubitril/valsartan in pediatric (1 month to <18 years) HF patients with systemic left ventricle and reduced left ventricular systolic function stratified into 3 age groups (Group 1: 6 to <18 years; Group 2: 1 to <6 years; Group 3: 1 month to <1 year). Part 2 is a 52-week, efficacy and safety study where 360 eligible patients will be randomized to sacubitril/valsartan or enalapril. A novel global rank primary endpoint derived by ranking patients (worst-to-best outcome) based on clinical events such as death, initiation of mechanical life support, listing for urgent heart transplant, worsening HF, measures of functional capacity (NYHA/Ross scores), and patient-reported HF symptoms will be used to assess efficacy. CONCLUSION The PANORAMA-HF study, which will be the largest prospective pediatric HF trial conducted to date and the first to use a global rank primary endpoint, will determine whether sacubitril/valsartan is superior to enalapril for treatment of pediatric HF patients with reduced systemic left ventricular systolic function.
Collapse
Affiliation(s)
| | | | - Nancy Halnon
- University of California Los Angeles, Los Angeles, CA
| | | | - Joseph Rossano
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Ziqiang Zhao
- Novartis Pharmaceuticals Corporation, Shanghai, China
| | | | - Michael Burch
- Great Ormond Street Hospital for Children, London, UK
| | - Fabian Chen
- Novartis Pharmaceuticals Corporation, Shanghai, China.
| |
Collapse
|
23
|
Bonnet D, Berger F, Jokinen E, Kantor PF, Daubeney PEF. Ivabradine in Children With Dilated Cardiomyopathy and Symptomatic Chronic Heart Failure. J Am Coll Cardiol 2017; 70:1262-1272. [PMID: 28859790 DOI: 10.1016/j.jacc.2017.07.725] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/05/2017] [Accepted: 07/10/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Heart rate reduction as a therapeutic target has been investigated in adults with heart failure (HF). Ivabradine has shown promising efficacy, but has not been evaluated in children. Currently, treatment recommendations for chronic pediatric HF are based mainly on chronic HF guidelines for adults. OBJECTIVES The authors explored the dose-response relationship of ivabradine in children with dilated cardiomyopathy and symptomatic chronic HF. The primary endpoint was ≥20% reduction in heart rate from baseline without inducing bradycardia or symptoms. METHODS This was a randomized, double-blind, placebo-controlled, phase II/III study with 12 months of follow-up. Children (n = 116) receiving stable HF therapy were randomized to either ivabradine or placebo. After an initial titration period, the dose was adjusted to attain the primary endpoint. Left ventricular function (echocardiography), clinical status (New York Heart Association functional class or Ross class), N-terminal pro-B-type natriuretic peptide, and quality of life (QOL) were assessed. RESULTS The primary endpoint was reached by 51 of 73 children taking ivabradine (70%) versus 5 of 41 taking placebo (12%) at varying doses (odds ratio: 17.24; p < 0.0001). Between baseline and 12 months, there was a greater increase in left ventricular ejection fraction in patients taking ivabradine than placebo (13.5% vs. 6.9%; p = 0.024). New York Heart Association functional class or Ross class improved more with ivabradine at 12 months than placebo (38% vs. 25%; p = 0.24). There was a trend toward improvement in QOL for ivabradine versus placebo (p = 0.053). N-terminal pro-B-type natriuretic peptide levels decreased similarly in both groups. Adverse events were reported at similar frequencies for ivabradine and placebo. CONCLUSIONS Ivabradine safely reduced the resting heart rate of children with chronic HF and dilated cardiomyopathy. Ivabradine's effect on heart rate was variable, highlighting the importance of dose titration. Ivabradine treatment improved left ventricular ejection fraction, and clinical status and QOL showed favorable trends. (Determination of the efficacious and safe dose of ivabradine in paediatric patients with dilated cardiomyopathy and symptomatic chronic heart failure from ages 6 months to 18 years; ISRCTN60567801).
Collapse
Affiliation(s)
- Damien Bonnet
- M3C-Necker, Hôpital Necker Enfants Malades, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - Felix Berger
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eero Jokinen
- Department of Pediatrics, Division of Pediatric C, Helsinki University Children's Hospital, Helsinki, Finland
| | - Paul F Kantor
- University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | |
Collapse
|
24
|
Translating clinical trials into clinical practice: a survey assessing the potential impact of the Pediatric Heart Network Infant Single Ventricle Trial. Cardiol Young 2017; 27:1265-1270. [PMID: 28183375 PMCID: PMC5721352 DOI: 10.1017/s104795111600295x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND A few studies have evaluated the impact of clinical trial results on practice in paediatric cardiology. The Infant Single Ventricle (ISV) Trial results published in 2010 did not support routine use of the angiotensin-converting enzyme inhibitor enalapril in infants with single-ventricle physiology. We sought to assess the influence of these findings on clinical practice. METHODS A web-based survey was distributed via e-mail to over 2000 paediatric cardiologists, intensivists, cardiothoracic surgeons, and cardiac advance practice nurses during three distribution periods. The results were analysed using McNemar's test for paired data and Fisher's exact test. RESULTS The response rate was 31.5% (69% cardiologists and 65% with >10 years of experience). Among respondents familiar with trial results, 74% reported current practice consistent with trial findings versus 48% before trial publication (p<0.001); 19% used angiotensin-converting enzyme inhibitor in this population "almost always" versus 36% in the past (p<0.001), and 72% reported a change in management or improved confidence in treatment decisions involving this therapy based on the trial results. Respondents familiar with trial results (78%) were marginally more likely to practise consistent with the trial results than those unfamiliar (74 versus 67%, p=0.16). Among all respondents, 28% reported less frequent use of angiotensin-converting enzyme inhibitor over the last 3 years. CONCLUSIONS Within 5 years of publication, the majority of respondents was familiar with the Infant Single Ventricle Trial results and reported less frequent use of angiotensin-converting enzyme inhibitor in single-ventricle infants; however, 28% reported not adjusting their clinical decisions based on the trial's findings.
Collapse
|
25
|
Ramachandran S, Lowenthal A, Ritner C, Lowenthal S, Bernstein HS. Plasma microvesicle analysis identifies microRNA 129-5p as a biomarker of heart failure in univentricular heart disease. PLoS One 2017; 12:e0183624. [PMID: 28859128 PMCID: PMC5578659 DOI: 10.1371/journal.pone.0183624] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/08/2017] [Indexed: 12/21/2022] Open
Abstract
Biomarkers of heart failure in adults have been extensively studied. However, biomarkers to monitor the progression of heart failure in children with univentricular physiology are less well understood. We proposed that as mediators of diverse pathophysiology, miRNAs contained within circulating microvesicles could serve as biomarkers for the presence and progression of heart failure in univentricular patients. To test this, we studied the association of heart failure with elevations in specific miRNAs isolated from circulating microvesicles in a cohort of children with univentricular heart disease and heart failure. We conducted a single site cross-sectional observational study of 71 children aged 1 month-7 years with univentricular heart disease and heart failure. We demonstrated that levels of miR129-5p isolated from plasma microvesicles were inversely related to the degree of clinical heart failure as assessed by Ross score. We then showed that miR129-5p levels are downregulated in HL1 cells and human embryonic stem cell-derived cardiomyocytes exposed to oxidative stress. We demonstrated that bone morphogenetic protein receptor 2, which has been implicated in the development of pulmonary vascular disease, is a target of miR129-5p, and conversely regulated in response to oxidative stress in cell culture. Levels of miR129-5p were inversely related to the degree of clinical heart failure in patients with univentricular heart disease. This study demonstrates that miR129-5p is a sensitive and specific biomarker for heart failure in univentricular heart disease independent of ventricular morphology or stage of palliation. Further study is warranted to understand the targets affected by miR129-5p with the development of heart failure in patients with univentricular physiology.
Collapse
Affiliation(s)
- Sweta Ramachandran
- Department of Pediatrics and Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, United States of America
| | - Alexander Lowenthal
- Department of Pediatrics and Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, United States of America
| | - Carissa Ritner
- Department of Pediatrics and Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, United States of America
| | - Shiri Lowenthal
- Department of Pediatrics and Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, United States of America
| | - Harold S. Bernstein
- Department of Pediatrics and Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, United States of America
- Department of Pediatrics and the Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- * E-mail:
| |
Collapse
|
26
|
Neonatal dilated cardiomyopathy. Rev Port Cardiol 2017; 36:201-214. [DOI: 10.1016/j.repc.2016.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/25/2016] [Accepted: 10/06/2016] [Indexed: 01/09/2023] Open
|
27
|
Neonatal dilated cardiomyopathy. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
28
|
Bozkurt B, Colvin M, Cook J, Cooper LT, Deswal A, Fonarow GC, Francis GS, Lenihan D, Lewis EF, McNamara DM, Pahl E, Vasan RS, Ramasubbu K, Rasmusson K, Towbin JA, Yancy C. Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e579-e646. [PMID: 27832612 DOI: 10.1161/cir.0000000000000455] [Citation(s) in RCA: 427] [Impact Index Per Article: 53.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
29
|
The evolution of medical therapy for children with heart failure. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2016.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
30
|
Abstract
OBJECTIVES The objectives of this review are to discuss the paradigms used to stage heart failure in children, the classification and physiologic profile of cardiomyopathies, and the acute and chronic pharmacologic management of heart failure. DATA SOURCE MEDLINE, PubMed. CONCLUSION The etiology of chronic heart failure in pediatrics is vast. The paradigm of extrapolating adult clinical trials and technological advancements to treat heart failure in children has become a nonsustainable model. The field of pediatric heart failure continues to advance with more robust guideline-directed care and the imminent creation of a dynamic, contemporary international database. As the field involves a markedly heterogeneous patient population, it is imperative to use pediatric specific descriptors of disease impact. The fields of pediatric heart failure and critical care medicine will continue to evolve together as childhood specific registries, quality improvement guidelines, and research will lead to practice models eliciting optimal therapy for patients with heart failure in the intensive care setting.
Collapse
|
31
|
Aguilar-Segura PR, Márquez-González H, Antúnez-Sánchez SP, Yáñez-Gutiérrez L, Estrada-Loeza MDJ, Meléndez-Ramírez G. Correlación entre la resonancia magnética y la ecocardiografía transtorácica en la evaluación de la insuficiencia pulmonar en pacientes pediátricos con cardiopatía congénita. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2015.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
32
|
Drug Treatment of Heart Failure in Children: Focus on Recent Recommendations from the ISHLT Guidelines for the Management of Pediatric Heart Failure. Paediatr Drugs 2016; 18:89-99. [PMID: 26939781 DOI: 10.1007/s40272-016-0166-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The International Society of Heart and Lung Transplantation (ISHLT) recently updated consensus pediatric heart failure guidelines from those published in 2004 with an aim to provide a practical evidence-based resource whilst recognizing the influence of adult heart failure practice. The new guidelines were formed from published evidence for heart failure management and used parallels with adult literature where pediatric evidence was lacking. This is a summary of the pharmacological therapies discussed in the new 2014 guidelines, emphasizing changes from the previous recommendations with regards to treatment of chronic heart failure with reduced ejection fraction, chronic heart failure with preserved ejection fraction, and acute decompensated heart failure. Each recommendation is classified according to strength and level of evidence. We also discuss future perspectives in the pharmacological treatment of heart failure. The 2014 ISHLT guidelines have evolved considerably from those published in 2004 with extensive information surrounding the underlying pathophysiology, investigations and recommended treatment. The new guidelines contain a modest amount of new pediatric data on pharmacological therapies and extrapolate adult data when appropriate. It is likely that most new recommendations for pediatric heart failure will continue to be based on therapies of proven benefit in adult heart failure studies.
Collapse
|
33
|
Serum digoxin concentrations and clinical signs and symptoms of digoxin toxicity in the paediatric population. Cardiol Young 2016; 26:493-8. [PMID: 25912244 DOI: 10.1017/s1047951115000505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Serum digoxin levels have limited utility for determining digoxin toxicity in adults. Paediatric data assessing the utility of monitoring serum digoxin concentration are scarce. We sought to determine whether serum digoxin concentrations are associated with signs and symptoms of digoxin toxicity in children. METHODS We carried out a retrospective review of patients 2 ng/ml). RESULTS There were 87 patients who met study criteria (male 46%, mean age 8.4 years). CHD was present in 67.8% and electrocardiograms were performed in 72.4% of the patients. The most common indication for digoxin toxicity was heart failure symptoms (61.5%). Toxic serum digoxin concentrations were present in 6.9% of patients (mean 2.6 ng/ml). Symptoms associated with digoxin toxicity occurred in 48.4%, with nausea/vomiting as the most common symptom (36.4%), followed by tachycardia (29.5%). Compared with those without toxic serum digoxin concentrations, significantly more patients with toxic serum digoxin concentrations were female (p=0.02). The presence of electrocardiogram abnormalities and/or signs and symptoms of digoxin toxicity was not significantly different between patients with and without serum digoxin concentrations (p>0.05). CONCLUSION Serum digoxin concentrations in children are not strongly associated with signs and symptoms of digoxin toxicity.
Collapse
|
34
|
Ross HJ, Law Y, Book WM, Broberg CS, Burchill L, Cecchin F, Chen JM, Delgado D, Dimopoulos K, Everitt MD, Gatzoulis M, Harris L, Hsu DT, Kuvin JT, Martin CM, Murphy AM, Singh G, Spray TL, Stout KK. Transplantation and Mechanical Circulatory Support in Congenital Heart Disease. Circulation 2016; 133:802-20. [DOI: 10.1161/cir.0000000000000353] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
35
|
Stout KK, Broberg CS, Book WM, Cecchin F, Chen JM, Dimopoulos K, Everitt MD, Gatzoulis M, Harris L, Hsu DT, Kuvin JT, Law Y, Martin CM, Murphy AM, Ross HJ, Singh G, Spray TL. Chronic Heart Failure in Congenital Heart Disease. Circulation 2016; 133:770-801. [DOI: 10.1161/cir.0000000000000352] [Citation(s) in RCA: 219] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
36
|
Brissaud O, Botte A, Cambonie G, Dauger S, de Saint Blanquat L, Durand P, Gournay V, Guillet E, Laux D, Leclerc F, Mauriat P, Boulain T, Kuteifan K. Experts' recommendations for the management of cardiogenic shock in children. Ann Intensive Care 2016; 6:14. [PMID: 26879087 PMCID: PMC4754230 DOI: 10.1186/s13613-016-0111-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/26/2016] [Indexed: 12/13/2022] Open
Abstract
Cardiogenic shock which corresponds to an acute state of circulatory failure due to impairment of myocardial contractility is a very rare disease in children, even more than in adults. To date, no international recommendations regarding its management in critically ill children are available. An experts’ recommendations in adult population have recently been made (Levy et al. Ann Intensive Care 5(1):52, 2015; Levy et al. Ann Intensive Care 5(1):26, 2015). We present herein recommendations for the management of cardiogenic shock in children, developed with the grading of recommendations’ assessment, development, and evaluation system by an expert group of the Groupe Francophone de Réanimation et Urgences Pédiatriques (French Group for Pediatric Intensive Care and Emergencies). The recommendations cover four major fields of application such as: recognition of early signs of shock and the patient pathway, management principles and therapeutic goals, monitoring hemodynamic and biological variables, and circulatory support (indications, techniques, organization, and transfer criteria). Major principle care for children with cardiogenic shock is primarily based on clinical and echocardiographic assessment. There are few drugs reported as effective in childhood in the medical literature. The use of circulatory support should be facilitated in terms of organization and reflected in the centers that support these children. Children with cardiogenic shock are vulnerable and should be followed regularly by intensivist cardiologists and pediatricians. The experts emphasize the multidisciplinary nature of management of children with cardiogenic shock and the importance of effective communication between emergency medical assistance teams (SAMU), mobile pediatric emergency units (SMUR), pediatric emergency departments, pediatric cardiology and cardiac surgery departments, and pediatric intensive care units.
Collapse
Affiliation(s)
- Olivier Brissaud
- Unité de Réanimation Pédiatrique et Néonatale, Hôpital des Enfants, CHU Pellegrin Enfants, Place Amélie Raba Léon, 33000, Bordeaux, France.
| | - Astrid Botte
- Unité de Réanimation Pédiatrique, Faculté de Médecine, Université de Lille Nord de France, Hôpital Jeanne de Flandre CHU de Lille, 54, Avenue Eugène Avinée, 59037, Lille Cedex, France
| | - Gilles Cambonie
- Département de Pédiatrie Néonatale et Réanimations, Pôle Hospitalo-Universitaire Femme-Mère-Enfant, Hôpital Arnaud-de-Villeneuve, Centre Hospitalier Régional Universitaire de Montpellier, 371, Avenue du Doyen-Gaston-Giraud, 34295, Montpellier Cedex 5, France
| | - Stéphane Dauger
- Réanimation et Surveillance Continue Pédiatriques, Pôle de Pédiatrie Médicale, Hôpital Robert-Debré, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, 48, Boulevard Sérurier, 75019, Paris, France
| | - Laure de Saint Blanquat
- Service de Réanimation, CHU Necker-Enfants-Malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France
| | - Philippe Durand
- Réanimation Pédiatrique, AP-HP, CHU Kremlin Bicêtre, 78, rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France
| | - Véronique Gournay
- Service de Cardiologie Pédiatrique, CHU de Nantes, 44093, Nantes Cedex, France
| | - Elodie Guillet
- Unité de Réanimation Pédiatrique et Néonatale, Hôpital des Enfants, CHU Pellegrin Enfants, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Daniela Laux
- Pôle des Cardiopathies Congénitales, Centre Chirurgical Marie Lannelongue, 133, Avenue de la Résistance, 92350, Le Plessis-Robinson, France
| | - Francis Leclerc
- Unité de Réanimation Pédiatrique, Faculté de Médecine, Université de Lille Nord de France, Hôpital Jeanne de Flandre CHU de Lille, 54, Avenue Eugène Avinée, 59037, Lille Cedex, France
| | - Philippe Mauriat
- Service de Cardiologie Pédiatrique et Congénitale, Hôpital Haut-Lévèque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac Cedex, France
| | - Thierry Boulain
- Service de Réanimation Polyvalente, Hôpital de La Source, Centre Hospitalier Régional Orléans, 45067, Orléans, France
| | - Khaldoun Kuteifan
- Service de Réanimation Médicale, Hôpital Émile-Muller, 68070, Mulhouse, France
| |
Collapse
|
37
|
Shi WY, Rouse M, Weintraub RG, Zannino D, Shipp A, d'Udekem Y, Konstantinov IE. Predictors of outcomes in children awaiting heart transplantation: an experience from a National Paediatric Heart Transplantation Programme. Eur J Cardiothorac Surg 2016; 49:1711-8. [PMID: 26802205 DOI: 10.1093/ejcts/ezv465] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 11/25/2015] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES The risk of mortality while awaiting heart transplantation (HT) may be greater in the setting of a smaller population and lower donor organ rates. Optimizing allocation policy and identifying the most vulnerable patients will help reduce mortality. As such, we aimed to evaluate the predictors of outcomes in patients awaiting HT as part of a National Paediatric HT Programme. METHODS Between 1988 and 2015, 200 children were listed for HT as part of a National Paediatric HT Programme. We categorized patients as experiencing one of four competing events: (i) transplant, (ii) death, (iii) delisting for clinical deterioration and (iv) delisting for clinical improvement. Comparison was made across three study eras: Era 1: 1988-95; Era 2: 1996-2005; Era 3: 2006-15. A multivariable competing risk regression analysis was performed to determine the independent predictors of transplantation and the composite event of death or delisting for clinical deterioration. RESULTS Among the 200 patients listed, 60% (119/200) underwent transplantation, 22% (44/200) died on the waiting list, 7% (13/200) were delisted for clinical deterioration and 11% (21/200) were delisted due to clinical improvement, with 2% (3/200) being still active on the waiting list. The mortality-rate for patients who remained on the waiting list decreased from 27% in Era 1 to 18% in Era 3. The survival from wait-listing was 57, 47 and 39% at 5, 10 and 15 years, respectively. On multivariable competing risk regression, older age (HR 1.09, 95% CI 1.01-1.18, P = 0.029) and the absence of inotropic support (HR 2.22, 1.23-4.00, P = 0.0073) were predictors of reaching transplantation. Higher creatinine (per 20 µmol/l, HR 1.42, 1.03-1.95, P = 0.03) was a predictor of the composite endpoint of death or delisting for deterioration. CONCLUSIONS In this analysis of a National Paediatric HT Programme, waiting-list mortality has decreased over time though it remains higher than countries with higher donor rates. The requirement for inotropic support and worsening renal function were predictors of failure to reach transplantation. These patients are likely to benefit the most from ventricular-assist device therapy and higher priority listing.
Collapse
Affiliation(s)
- William Y Shi
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia Murdoch Children's Research Institute, Melbourne, Australia University of Melbourne, Melbourne, Australia
| | - Michael Rouse
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Robert G Weintraub
- Murdoch Children's Research Institute, Melbourne, Australia University of Melbourne, Melbourne, Australia Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
| | - Diana Zannino
- Murdoch Children's Research Institute, Melbourne, Australia University of Melbourne, Melbourne, Australia
| | - Anne Shipp
- Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia Murdoch Children's Research Institute, Melbourne, Australia University of Melbourne, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia Murdoch Children's Research Institute, Melbourne, Australia University of Melbourne, Melbourne, Australia
| |
Collapse
|
38
|
Stein ML, Dao DT, Doan LN, Reinhartz O, Maeda K, Hollander SA, Yeh J, Kaufman BD, Almond CS, Rosenthal DN. Ventricular assist devices in a contemporary pediatric cohort: Morbidity, functional recovery, and survival. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2015.06.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
39
|
Kero A, Madanat-Harjuoja L, Järvelä L, Malila N, Matomäki J, Lähteenmäki P. Cardiovascular medication after cancer at a young age in Finland: A nationwide registry linkage study. Int J Cancer 2015; 139:683-90. [DOI: 10.1002/ijc.29943] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/18/2015] [Indexed: 12/23/2022]
Affiliation(s)
- A.E. Kero
- Department of Pediatric and Adolescent Medicine; Turku University Hospital and Turku University; Turku Finland
| | - L.M. Madanat-Harjuoja
- Department of Pediatrics; University of Helsinki and Helsinki University Hospital; Helsinki Finland
- Finnish Cancer Registry; Helsinki Finland
| | - L.S. Järvelä
- Department of Pediatric and Adolescent Medicine; Turku University Hospital and Turku University; Turku Finland
| | - N. Malila
- Finnish Cancer Registry; Helsinki Finland
- School of Health Sciences; University of Tampere; Tampere Finland
| | - J. Matomäki
- Turku Clinical Research Center, Turku University Hospital; Finland
| | - P.M. Lähteenmäki
- Department of Pediatric and Adolescent Medicine; Turku University Hospital and Turku University; Turku Finland
| |
Collapse
|
40
|
Fabiano V, Carnovale C, Gentili M, Radice S, Zuccotti GV, Clementi E, Perrotta C, Mameli C. Enalapril Associated with Furosemide Induced Acute Kidney Injury in an Infant with Heart Failure. A Case Report, a Revision of the Literature and a Pharmacovigilance Database Analysis. Pharmacology 2015; 97:38-42. [DOI: 10.1159/000441950] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/26/2015] [Indexed: 11/19/2022]
|
41
|
Davies RR, Haldeman S, McCulloch MA, Gidding SS, Pizarro C. Low body mass index is associated with increased waitlist mortality among children listed for heart transplant. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.05.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
42
|
Task Force 7: Pediatric Cardiology Fellowship Training in Pulmonary Hypertension, Advanced Heart Failure, and Transplantation. Circulation 2015; 132:e99-e106. [DOI: 10.1161/cir.0000000000000198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
43
|
Webber SA, Hsu DT, Ivy DD, Kulik TJ, Pahl E, Rosenthal DN, Morrow WR, Feinstein JA. Task Force 7: Pediatric Cardiology Fellowship Training in Pulmonary Hypertension, Advanced Heart Failure, and Transplantation. J Am Coll Cardiol 2015; 66:732-9. [DOI: 10.1016/j.jacc.2015.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
44
|
Review of the International Society for Heart and Lung Transplantation Practice guidelines for management of heart failure in children. Cardiol Young 2015; 25 Suppl 2:154-9. [PMID: 26377722 DOI: 10.1017/s1047951115000955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In 2004, practice guidelines for the management of heart failure in children by Rosenthal and colleagues were published in conjunction with the International Society for Heart and Lung Transplantation. These guidelines have not been updated or reviewed since that time. In general, there has been considerable controversy as to the utility and purpose of clinical practice guidelines, but there is general recognition that the relentless progress of medicine leads to the progressive irrelevance of clinical practice guidelines that do not undergo periodic review and updating. Paediatrics and paediatric cardiology, in particular, have had comparatively minimal participation in the clinical practice guidelines realm. As a result, most clinical practice guidelines either specifically exclude paediatrics from consideration, as has been the case for the guidelines related to cardiac failure in adults, or else involve clinical practice guidelines committees that include one or two paediatric cardiologists and produce guidelines that cannot reasonably be considered a consensus paediatric opinion. These circumstances raise a legitimate question as to whether the International Society for Heart and Lung Transplantation paediatric heart failure guidelines should be re-reviewed. The time, effort, and expense involved in producing clinical practice guidelines should be considered before recommending an update to the International Society for Heart and Lung Transplantation Paediatric Heart Failure guidelines. There are specific areas of rapid change in the evaluation and management of heart failure in children that are undoubtedly worthy of updating. These domains include areas such as use of serum and imaging biomarkers, wearable and implantable monitoring devices, and acute heart failure management and mechanical circulatory support. At the time the International Society for Heart and Lung Transplantation guidelines were published, echocardiographic tissue Doppler, 3 dimensional imaging, and strain and strain rate were either novel or non-existent and have now moved into the main stream. Cardiac magnetic resonance imaging (MRI) had very limited availability, and since that time imaging and assessment of myocardial iron content, delayed gadolinium enhancement, and extracellular volume have moved into the mainstream. The only devices discussed in the International Society for Heart and Lung Transplantation guidelines were extracorporeal membrane oxygenators, pacemakers, and defibrillators. Since that time, ventricular assist devices have become mainstream. Despite the relative lack of randomised controlled trials in paediatric heart failure, advances continue to occur. These advances warrant implementation of an update and review process, something that is best done under the auspices of the national and international cardiology societies. A joint activity that includes the International Society for Heart and Lung Transplantation, American College of Cardiology/American Heart Association, the Association for European Paediatric and Congenital Cardiology (AEPC), European Society of Cardiology, Canadian Cardiovascular Society, and others will have more credibility than independent efforts by any of these organisations.
Collapse
|
45
|
Shaddy RE. Developing evidence-based treatments for the management of pediatric heart failure. PROGRESS IN PEDIATRIC CARDIOLOGY 2015. [DOI: 10.1016/j.ppedcard.2015.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
46
|
Ehrhardt MJ, Armenian SH, Fulbright JM. Screening and intervention for treatment-related cardiac dysfunction in childhood cancer survivors. Future Oncol 2015. [DOI: 10.2217/fon.15.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Matthew J Ehrhardt
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN 381053, USA
| | - Saro H Armenian
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Joy M Fulbright
- Division of Pediatric Hematology, Oncology & Bone Marrow Transplantation, Children's Mercy, Kansas City, MO 64108, USA
| |
Collapse
|
47
|
Séguéla PE, Mauriat P, Mouton JB, Tafer N, Assy J, Poncelet G, Nubret K, Iriart X, Thambo JB. Single-centred experience with levosimendan in paediatric decompensated dilated cardiomyopathy. Arch Cardiovasc Dis 2015; 108:347-55. [DOI: 10.1016/j.acvd.2015.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 12/07/2014] [Accepted: 01/26/2015] [Indexed: 01/22/2023]
|
48
|
Armenian SH, Kremer LC, Sklar C. Approaches to reduce the long-term burden of treatment-related complications in survivors of childhood cancer. Am Soc Clin Oncol Educ Book 2015:196-204. [PMID: 25993157 DOI: 10.14694/edbook_am.2015.35.196] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Advances in diagnostics, treatment strategies, and supportive care have contributed to a marked improvement in outcomes for children with cancer. This has resulted in a growing number of long-term childhood cancer survivors. Currently there are over 360,000 individuals who are survivors of childhood cancer in the United States. However, treatment for patients with childhood cancer with chemotherapy, radiation, and/or hematopoietic stem cell transplantation can result in health-related complications that may not become evident until years after completion of treatment. As a result, several initiatives have been established to help standardize the surveillance for treatment-related late effects in childhood cancer survivors. This review highlights emerging concepts related to commonly reported late effects, such as subsequent malignant neoplasms, cardiovascular disease, and endocrinopathies. It also discusses relevant population-based screening strategies to mitigate the long-term health-related burden in vulnerable populations of survivors.
Collapse
Affiliation(s)
- Saro H Armenian
- From the Department of Population Sciences, City of Hope, Duarte, CA; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leontien C Kremer
- From the Department of Population Sciences, City of Hope, Duarte, CA; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Charles Sklar
- From the Department of Population Sciences, City of Hope, Duarte, CA; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
49
|
Armenian SH, Hudson MM, Mulder RL, Chen MH, Constine LS, Dwyer M, Nathan PC, Tissing WJE, Shankar S, Sieswerda E, Skinner R, Steinberger J, van Dalen EC, van der Pal H, Wallace WH, Levitt G, Kremer LCM. Recommendations for cardiomyopathy surveillance for survivors of childhood cancer: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2015; 16:e123-36. [PMID: 25752563 PMCID: PMC4485458 DOI: 10.1016/s1470-2045(14)70409-7] [Citation(s) in RCA: 358] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Survivors of childhood cancer treated with anthracycline chemotherapy or chest radiation are at an increased risk of developing congestive heart failure. In this population, congestive heart failure is well recognised as a progressive disorder, with a variable period of asymptomatic cardiomyopathy that precedes signs and symptoms. As a result, several clinical practice guidelines have been developed independently to help with detection and treatment of asymptomatic cardiomyopathy. These guidelines differ with regards to definitions of at-risk populations, surveillance modality and frequency, and recommendations for interventions. Differences between these guidelines could hinder the effective implementation of these recommendations. We report on the results of an international collaboration to harmonise existing cardiomyopathy surveillance recommendations using an evidence-based approach that relied on standardised definitions for outcomes of interest and transparent presentation of the quality of the evidence. The resultant recommendations were graded according to the quality of the evidence and the potential benefit gained from early detection and intervention.
Collapse
Affiliation(s)
- Saro H Armenian
- Department of Population Sciences, City of Hope, Duarte, USA.
| | - Melissa M Hudson
- Departments of Oncology and Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Renee L Mulder
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, Netherlands
| | - Ming Hui Chen
- Department of Pediatrics, Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Mary Dwyer
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
| | - Paul C Nathan
- The Hospital for Sick Children and the University of Toronto, Department of Pediatrics and Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada
| | - Wim J E Tissing
- Division of Pediatric Oncology and Pediatric Hematology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Sadhna Shankar
- Division of Oncology, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA
| | - Elske Sieswerda
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, Netherlands
| | - Rod Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and University of Newcastle, Newcastle upon Tyne, UK
| | - Julia Steinberger
- Department of Pediatrics, Division of Cardiology, University of Minnesota Amplatz Childrens' Hospital, Minneapolis, MN, USA
| | - Elvira C van Dalen
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Helena van der Pal
- Department of Pediatric Oncology and Medical Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, Netherlands
| | - W Hamish Wallace
- Department of Hematology/Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Gill Levitt
- Department of Oncology/Haematology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, Netherlands
| |
Collapse
|
50
|
Armenian SH. Improving screening practices in childhood cancer survivors at risk for treatment-related heart failure. J Clin Oncol 2014; 32:3923-5. [PMID: 25366690 DOI: 10.1200/jco.2014.58.5562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|