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Clinical, electrocardiographic, and histologic correlations in children with dilated cardiomyopathy
A W Nugent1, A M Davis, S Kleinert
1Department of Cardiology, Royal Children's Hospital, Parkville, Melbourne, Australia.
Insights
Electrocardiography cannot reliably predict heart inflammation in children with dilated cardiomyopathy. However, children with lymphocytic myocarditis showed better survival and outcomes than those with non-specific findings.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Pathology
- Diagnostic Imaging
Background:
- Lymphocytic myocarditis is a key cause of childhood dilated cardiomyopathy with uncertain prognosis.
- Non-invasive tests are often used to diagnose lymphocytic myocarditis.
Purpose of the Study:
- To investigate the relationship between presenting electrocardiography (ECG) findings and histologic diagnoses in children with dilated cardiomyopathy.
- To assess if ECG can predict clinical outcomes in these patients.
Main Methods:
- Thirty-four children with acute dilated cardiomyopathy underwent early ECG and endomyocardial biopsy.
- ECG parameters (heart rate, intervals, R/S wave voltages) were analyzed as Z scores.
- Histologic findings were categorized into lymphocytic myocarditis or non-specific changes.
Main Results:
- Fifteen patients had lymphocytic myocarditis (Group I), 19 had non-specific histology (Group II).
- Group I showed significantly smaller R-wave and combined S/R wave Z scores in specific leads (p < 0.02).
- Survival and freedom from cardiac dysfunction were better in Group I (p <= 0.02).
Conclusions:
- Presenting ECG findings do not reliably indicate myocardial histology in pediatric dilated cardiomyopathy.
- Children with lymphocytic myocarditis have a better prognosis than those with non-specific histology.
Objective:
To determine whether presenting electrocardiography is related to histologic findings and clinical outcomes in children with dilated cardiomyopathy.
Background:
Lymphocytic myocarditis is an important cause of childhood dilated cardiomyopathy, the outcome of which is unclear. The results of non-invasive investigations are often used to infer the presence or absence of lymphocytic myocarditis.
Methods:
Thirty-four children, presenting acutely with dilated cardiomyopathy, underwent both early electrocardiography and endomyocardial biopsy. The parameters examined included heart rate, PR, QRS, and corrected QT intervals, R-wave voltages in Leads V(1) and V(6), S-wave voltages in Leads V(1) and V(6), and sum of SV(1) and RV(6). We expressed measurements as Z scores, based on published normal values for age and gender.
Results:
A total of 15 patients had lymphocytic myocarditis on endomyocardial biopsy (Group I), and 19 had non-specific histologic findings (Group II). We did not distinguish the 2 groups by age, time to endomyocardial biopsy, or duration of follow-up. Group I patients had significantly smaller R-wave Z scores in Leads V(1) and V(6), and combined S in V(1) and R in V(6) Z scores (p < 0.02 for each). The positive and negative predictive values of an R-wave amplitude in V(6) < 5th percentile were 75% and 65%, respectively, for the diagnosis of lymphocytic myocarditis. An R-wave amplitude in V(6) > 95th percentile had a positive and negative predictive value of 80% and 63%, respectively, for the diagnosis of idiopathic dilated cardiomyopathy. Survival and freedom from late cardiac dysfunction were more common among Group I patients compared with Group II (p
Conclusion:
Myocardial histology cannot reliably be inferred from the presenting electrocardiogram. Survival and outcome for children with lymphocytic myocarditis is better than for those with non-specific histology.