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van der Meulen MH, Herkert JC, den Boer SL, du Marchie Sarvaas GJ, Blom N, ten Harkel AD, Breur HM, Rammeloo LA, Tanke R, Marcelis C, van de Laar IM, Verhagen JM, Lekanne dit Deprez RH, Barge-Schaapveld DQ, Baas A, Sammani A, Christiaans I, van Tintelen JP, Dalinghaus M. Genetic Evaluation of A Nation-Wide Dutch Pediatric DCM Cohort: The Use of Genetic Testing in Risk Stratification. Circ Genom Precis Med 2022; 15:e002981. [DOI: 10.1161/circgen.120.002981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
This study aimed to describe the current practice and results of genetic evaluation in Dutch children with dilated cardiomyopathy and to evaluate genotype-phenotype correlations that may guide prognosis.
Methods:
We performed a multicenter observational study in children diagnosed with dilated cardiomyopathy, from 2010 to 2017.
Results:
One hundred forty-four children were included. Initial diagnostic categories were idiopathic dilated cardiomyopathy in 67 children (47%), myocarditis in 23 (16%), neuromuscular in 7 (5%), familial in 18 (13%), inborn error of metabolism in 4 (3%), malformation syndrome in 2 (1%), and “other” in 23 (16%). Median follow-up time was 2.1 years [IQR 1.0–4.3]. Hundred-seven patients (74%) underwent genetic testing. We found a likely pathogenic or pathogenic variant in 38 children (36%), most often in
MYH7
(n = 8). In 1 patient initially diagnosed with myocarditis, a pathogenic
LMNA
variant was found. During the study, 39 patients (27%) reached study endpoint (SE: all-cause death or heart transplantation). Patients with a likely pathogenic or pathogenic variant were more likely to reach SE compared with those without (hazard ratio 2.8; 95% CI 1.3–5.8,
P
= 0.007), while transplant-free survival was significantly lower (
P
= 0.006). Clinical characteristics at diagnosis did not differ between the 2 groups.
Conclusions:
Genetic testing is a valuable tool for predicting prognosis in children with dilated cardiomyopathy, with carriers of a likely pathogenic or pathogenic variant having a worse prognosis overall. Genetic testing should be incorporated in clinical work-up of all children with dilated cardiomyopathy regardless of presumed disease pathogenesis.
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Affiliation(s)
| | - Johanna C. Herkert
- Dept of Genetics, Univ of Groningen, Univ Medical Center Groningen, Groningen (J.C.H., I.C.)
| | | | | | - Nico Blom
- Dept of Pediatric Cardiology, Univ of Leiden, Leiden Univ Medical Center, Leiden (N.B., A.D.J.H.)
| | - Arend D.J. ten Harkel
- Dept of Pediatric Cardiology, Univ of Leiden, Leiden Univ Medical Center, Leiden (N.B., A.D.J.H.)
- Dept of Pediatric Cardiology, Univ of Amsterdam, Academic Medical Center, Amsterdam (A.D.J.H.)
| | - Hans M.P.J. Breur
- Dept of Pediatric Cardiology, Univ of Utrecht, Wilhelmina Children’s Hospital, Univ Medical Center Utrecht, Utrecht (H.M.P.J.B.)
| | - Lukas A.J. Rammeloo
- Dept of Pediatric Cardiology, Amsterdam Univ Medical Center, location Free Univ Medical Center, Amsterdam (L.A.J.R.)
| | - Ronald Tanke
- Dept of Pediatric Cardiology, Radboud Univ Medical Center, Nijmegen (R.T.)
| | - Carlo Marcelis
- Dept of Genetics, Radboud Univ Medical Center, Nijmegen (C.M.)
| | - Ingrid M.B.H. van de Laar
- Dept of Clinical Genetics, Erasmus MC, Univ Medical Center Rotterdam, Rotterdam (I.M.B.H.L., J.M.A.V.)
| | - Judith M.A. Verhagen
- Dept of Clinical Genetics, Erasmus MC, Univ Medical Center Rotterdam, Rotterdam (I.M.B.H.L., J.M.A.V.)
| | | | | | - Annette Baas
- Dept of Genetics, Univ of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands (A.B., A.S., J.P.T.)
| | - Arjan Sammani
- Dept of Genetics, Univ of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands (A.B., A.S., J.P.T.)
| | - Imke Christiaans
- Dept of Genetics, Univ of Groningen, Univ Medical Center Groningen, Groningen (J.C.H., I.C.)
- Dept of Clinical Genetics, Univ of Leiden, Leiden Univ Medical Center, Leiden (D.Q.C.M.B-S., I.C.)
| | - J. Peter van Tintelen
- Dept of Clinical Genetics, Amsterdam Univ Medical Center, location AMC, Amsterdam (R.H.L.D., J.P.T.)
- Dept of Genetics, Univ of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands (A.B., A.S., J.P.T.)
| | - Michiel Dalinghaus
- Dept of Pediatric Cardiology, Erasmus MC, Univ Medical Center Rotterdam, Rotterdam (M.H.M., M.D.)
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2
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Roest S, van der Meulen MH, van Osch-Gevers LM, Kraemer US, Constantinescu AA, de Hoog M, Bogers AJJC, Manintveld OC, van de Woestijne PC, Dalinghaus M. The Dutch national paediatric heart transplantation programme: outcomes during a 23-year period. Neth Heart J 2022; 31:68-75. [PMID: 35838916 PMCID: PMC9284482 DOI: 10.1007/s12471-022-01703-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Since 1998, there has been a national programme for paediatric heart transplantations (HT) in the Netherlands. In this study, we investigated waiting list mortality, survival post-HT, the incidence of common complications, and the patients' functional status during follow-up. METHODS All children listed for HT from 1998 until October 2020 were included. Follow-up lasted until 1 January 2021. Data were collected from the patient charts. Survival, post-operative complications as well as the functional status (Karnofsky/Lansky scale) at the end of follow-up were measured. RESULTS In total, 87 patients were listed for HT, of whom 19 (22%) died while on the waiting list. Four patients were removed from the waiting list and 64 (74%) underwent transplantation. Median recipient age at HT was 12.0 (IQR 7.2-14.4) years old; 55% were female. One-, 5‑, and 10-year survival post-HT was 97%, 95%, and 88%, respectively. Common transplant-related complications were rejections (50%), Epstein-Barr virus infections (31%), cytomegalovirus infections (25%), post-transplant lymphoproliferative disease (13%), and cardiac allograft vasculopathy (13%). The median functional score (Karnofsky/Lansky scale) was 100 (IQR 90-100). CONCLUSION Children who undergo HT have an excellent survival rate up to 10 years post-HT. Even though complications post-HT are common, the functional status of most patients is excellent. Waiting list mortality is high, demonstrating that donor availability for this vulnerable patient group remains a major limitation for further improvement of outcome.
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Affiliation(s)
- Stefan Roest
- Department of Paediatric Cardiology, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marijke H. van der Meulen
- Department of Paediatric Cardiology, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Lennie M. van Osch-Gevers
- Department of Paediatric Cardiology, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ulrike S. Kraemer
- Department of Paediatric Cardiology, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Department of Paediatric Intensive Care, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Alina A. Constantinescu
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Matthijs de Hoog
- Department of Paediatric Intensive Care, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ad J. J. C. Bogers
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Department of Cardiothoracic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Olivier C. Manintveld
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Pieter C. van de Woestijne
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Department of Cardiothoracic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Michiel Dalinghaus
- Department of Paediatric Cardiology, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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3
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Rohde S, Antonides CFJ, Muslem R, van de Woestijne PC, van der Meulen MH, Kraemer US, Dalinghaus M, Bogers AJJC. Pediatric Ventricular Assist Device Support in the Netherlands. World J Pediatr Congenit Heart Surg 2020; 11:275-283. [PMID: 32294020 PMCID: PMC7163248 DOI: 10.1177/2150135120902114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: This study aimed to evaluate the changes in heart transplantation (HTx) waiting list
mortality following the introduction of the Berlin Heart EXCOR (BH EXCOR) in the
Netherlands, as well as the occurrence of adverse events in these children. Methods: A retrospective, single-center study was conducted including all pediatric patients
(≤18 years) awaiting HTx. Patients were grouped in two eras based on availability of the
BH EXCOR in our center, era I (1998-2006; not available) and era II (2007 to July 31,
2018; available). Results: In total, 87 patients were included, 15 in era I and 72 in era II. Extracorporeal
membrane oxygenator support was required in 1 (7%) patient in era I and in 13 (18%)
patients in era II. Overall mortality (7/15 in era I vs 16/72 in era II; 47% vs 22%,
P = .06) and transplantation rates (8/15 in era I vs 47/72 in era II;
53% vs 65%, P = .39) did not differ significantly. Eleven (39%)
patients of the pediatric ventricular assist device (VAD) population died, with the
predominant cause being cerebrovascular accidents (CVAs) in eight (29%) patients.
Furthermore, 14 (50%) of the pediatric VAD patients survived to transplantation. Adverse
events most frequently occurring in VAD patients included CVA in 14 (50%), mostly (68%)
within 30 days after VAD implantation, and bleeding requiring rethoracotomy in 14 (50%),
all within 30 days after VAD implantation. Conclusions: The introduction of the BH EXCOR has positively impacted the survival of pediatric
patients with end-stage heart failure in our center. The predominant cause of death
changed from end-stage heart failure in era I to CVA in era II. We emphasize the need
for large prospective registry–based studies.
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Affiliation(s)
- Sofie Rohde
- Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the
Netherlands
| | | | - Rahatullah Muslem
- Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the
Netherlands
| | | | | | - Ulrike S. Kraemer
- Pediatric Cardiology, Erasmus University Medical Center, Rotterdam, the
Netherlands
- Pediatric Intensive Care Unit, Erasmus University Medical Center, Rotterdam,
the Netherlands
| | - Michiel Dalinghaus
- Pediatric Cardiology, Erasmus University Medical Center, Rotterdam, the
Netherlands
| | - Ad J. J. C. Bogers
- Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the
Netherlands
- Ad J. J. C. Bogers, Thoraxcenter, Room RG-619/625,
Erasmus University Medical Center, Dr Molewaterplein 40, 3015 GD, Rotterdam, the
Netherlands.
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4
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van der Mheen M, van der Meulen MH, den Boer SL, Schreutelkamp DJ, van der Ende J, de Nijs PFA, Breur JMPJ, Tanke RB, Blom NA, Rammeloo LAJ, ten Harkel ADJ, du Marchie Sarvaas GJ, Utens EMWJ, Dalinghaus M. Emotional and behavioral problems in children with dilated cardiomyopathy. Eur J Cardiovasc Nurs 2020; 19:291-300. [PMID: 31552760 PMCID: PMC7153220 DOI: 10.1177/1474515119876148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/25/2019] [Accepted: 08/23/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) in children is an important cause of severe heart failure and carries a poor prognosis. Adults with heart failure are at increased risk of anxiety and depression and such symptoms predict adverse clinical outcomes such as mortality. In children with DCM, studies examining these associations are scarce. AIMS We studied whether in children with DCM: (1) the level of emotional and behavioral problems was increased as compared to normative data, and (2) depressive and anxiety problems were associated with the combined risk of death or cardiac transplantation. METHODS To assess emotional and behavioral problems in children with DCM, parents of 68 children, aged 1.5-18 years (6.9±5.7 years), completed the Child Behavior Checklist. RESULTS Compared to normative data, more young children (1.5-5 years) with DCM had somatic complaints (24.3% vs. 8.0%; p < .001), but fewer had externalizing problems (5.4% vs. 17.0%; p = .049). Overall internalizing problems did not reach significance. Compared to normative data, more older children (6-18 years) showed internalizing problems (38.7% vs. 17.0%; p = .001), including depressive (29.0% vs. 8.0%; p < .001) and anxiety problems (19.4% vs. 8.0%; p = .023), and somatic complaints (29.0% vs. 8.0%; p < .001). Anxiety and depressive problems, corrected for heart failure severity, did not predict the risk of death or cardiac transplantation. CONCLUSION Children of 6 years and older showed more depressive and anxiety problems than the normative population. Moreover, in both age groups, somatic problems were common. No association with outcome could be demonstrated.
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Affiliation(s)
- Malindi van der Mheen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
| | | | - Susanna L den Boer
- Department of Pediatrics, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Dayenne J Schreutelkamp
- Department of Pediatric Intensive Care, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Pieter FA de Nijs
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Johannes MPJ Breur
- Department of Pediatrics, Wilhelmina Children’s Hospital, UMC Utrecht, The Netherlands
| | - Ronald B Tanke
- Department of Pediatrics, Radboud UMC, Nijmegen, The Netherlands
| | - Nico A Blom
- Department of Pediatrics, Amsterdam UMC, Emma Children’s Hospital, The Netherlands
| | - Lukas AJ Rammeloo
- Department of Pediatrics, Amsterdam UMC, VU University Medical Center, The Netherlands
| | | | | | - Elisabeth MWJ Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, The Netherlands
- Academic Centre for Child and Adolescent Psychiatry the Bascule, Amsterdam UMC, Academic Medical Centre, The Netherlands
| | - Michiel Dalinghaus
- Department of Pediatrics, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
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5
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van der Meulen MH, Boer SD, du Marchie Sarvaas GJ, Blom NA, ten Harkel ADJ, Breur HMPJ, Rammeloo LAJ, Tanke R, Helbing WA, Boersma E, Dalinghaus M. Does Repeated Measurement of a 6-Min Walk Test Contribute to Risk Prediction in Children with Dilated Cardiomyopathy? Pediatr Cardiol 2020; 41:223-229. [PMID: 31713652 PMCID: PMC7072046 DOI: 10.1007/s00246-019-02244-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/31/2019] [Indexed: 11/26/2022]
Abstract
A single 6-min walk test (6MWT) can be used to identify children with dilated cardiomyopathy (DCM) with a high risk of death or heart transplantation. To determine if repeated 6MWT has added value in addition to a single 6MWT in predicting death or heart transplantation in children with DCM. Prospective multicenter cohort study including ambulatory DCM patients ≥ 6 years. A 6MWT was performed 1 to 4 times per year. The distance walked was expressed as percentage of predicted (6MWD%). We compared the temporal evolution of 6MWD% in patients with and without the study endpoint (SE: all-cause death or heart transplantation), using a linear mixed effects model. In 57 patients, we obtained a median of 4 (IQR 2-6) 6MWTs per patient during a median of 3.0 years of observation (IQR 1.5-5.1). Fourteen patients reached a SE (3 deaths, 11 heart transplantations). At any time during follow-up, the average estimate of 6MWD% was significantly lower in patients with a SE compared to patients without a SE. In both patients groups, 6MWD% remained constant over time. An absolute 1% lower 6MWD% was associated with an 11% higher risk (hazard) of the SE (HR 0.90, 95% CI 0.86-0.95 p < 0.001). Children with DCM who died or underwent heart transplantation had systematically reduced 6MWD%. The performance of all patients was stable over time, so repeated measurement of 6MWT within this time frame had little added value over a single test.
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Affiliation(s)
- Marijke H. van der Meulen
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Susanna den Boer
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gideon J. du Marchie Sarvaas
- Department of Pediatric Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nico A. Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Arend D. J. ten Harkel
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans M. P. J. Breur
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lukas A. J. Rammeloo
- Department of Pediatric Cardiology, Free University Medical Center, Amsterdam, The Netherlands
| | - Ronald Tanke
- Department of Pediatric Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willem A. Helbing
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatric Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eric Boersma
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Michiel Dalinghaus
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatric Cardiology, Erasmus University Medical Center, Dr. Molewaterplein 60, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
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6
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den Boer SL, Flipse DHK, van der Meulen MH, Backx APCM, du Marchie Sarvaas GJ, Ten Harkel ADJ, van Iperen GG, Rammeloo LAJ, Tanke RB, Helbing WA, Takken T, Dalinghaus M. Six-Minute Walk Test as a Predictor for Outcome in Children with Dilated Cardiomyopathy and Chronic Stable Heart Failure. Pediatr Cardiol 2017; 38:465-471. [PMID: 27909753 PMCID: PMC5355503 DOI: 10.1007/s00246-016-1536-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 11/12/2016] [Indexed: 11/24/2022]
Abstract
Cardiopulmonary exercise testing is an important tool to predict prognosis in children and adults with heart failure. A much less sophisticated exercise test is the 6 min walk test, which has been shown an independent predictor for morbidity and mortality in adults with heart failure. Therefore, we hypothesized that the 6 min walk test could be predictive for outcome in children with dilated cardiomyopathy. We prospectively included 49 children with dilated cardiomyopathy ≥6 years who performed a 6 min walk test. Median age was 11.9 years (interquartile range [IQR] 7.4-15.1), median time after diagnosis was 3.6 years (IQR 0.6-7.4). The 6 min walk distance was transformed to a percentage of predicted, using age- and gender-specific norm values (6MWD%). For all patients, mean 6MWD% was 70 ± 21%. Median follow-up was 33 months (IQR 14-50). Ten patients reached the combined endpoint of death or heart transplantation. Using univariable Cox regression, a higher 6MWD% resulted in a lower risk of death or transplantation (hazard ratio 0.95 per percentage increase, p = 0.006). A receiver operating characteristic curve was generated to define the optimal threshold to identify patients at highest risk for an endpoint. Patients with a 6MWD% < 63% had a 2 year transplant-free survival of 73%, in contrast to a transplant-free survival of 92% in patients with a 6MWD% ≥ 63% (p = 0.003). In children with dilated cardiomyopathy, the 6 min walk test is a simple and feasible tool to identify children with a higher risk of death or heart transplantation.
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Affiliation(s)
- Susanna L. den Boer
- 000000040459992Xgrid.5645.2Division of Pediatric Cardiology, Sophia Children’s Hospital, Erasmus University Medical Center, Dr. Molewaterplein 60, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Daniël H. K. Flipse
- 000000040459992Xgrid.5645.2Division of Pediatric Cardiology, Sophia Children’s Hospital, Erasmus University Medical Center, Dr. Molewaterplein 60, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Marijke H. van der Meulen
- 000000040459992Xgrid.5645.2Division of Pediatric Cardiology, Sophia Children’s Hospital, Erasmus University Medical Center, Dr. Molewaterplein 60, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Ad P. C. M. Backx
- 0000000404654431grid.5650.6Division of Pediatric Cardiology, Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Gideon J. du Marchie Sarvaas
- 0000 0004 0407 1981grid.4830.fDivision of Pediatric Cardiology, Beatrix Children’s Hospital, University of Groningen, Groningen, The Netherlands
| | - Arend D. J. Ten Harkel
- 0000000089452978grid.10419.3dDivision of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Gabriëlle G. van Iperen
- 0000000090126352grid.7692.aDivision of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lukas A. J. Rammeloo
- 0000 0004 0435 165Xgrid.16872.3aDivision of Pediatric Cardiology, Department of Pediatrics, Free University Medical Center, Amsterdam, The Netherlands
| | - Ronald B. Tanke
- 0000 0004 0444 9382grid.10417.33Division of Pediatric Cardiology, Department of Pediatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willem A. Helbing
- 000000040459992Xgrid.5645.2Division of Pediatric Cardiology, Sophia Children’s Hospital, Erasmus University Medical Center, Dr. Molewaterplein 60, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Tim Takken
- 0000000090126352grid.7692.aChild Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel Dalinghaus
- Division of Pediatric Cardiology, Sophia Children's Hospital, Erasmus University Medical Center, Dr. Molewaterplein 60, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.
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