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[Clinical aspects and development of dilated cardiomyopathy in infants and children]
M A da Silva1, R P da Silva, S C de Morais
1Instituto Dante Pazzanese de Cardiologia, Estado de São Paulo.
Insights
Dilated cardiomyopathy (DCM) in infants and children shows a better prognosis than previously thought, especially in older children. Early diagnosis and management are crucial for improving outcomes in pediatric DCM.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Clinical Pediatrics
Context:
- Dilated cardiomyopathy (DCM) is a significant cause of heart failure in children.
- Understanding the clinical evolution and prognosis of pediatric DCM is essential for effective management.
- Distinguishing between different etiologies like myocarditis (IM) and endocardial fibroelastosis (EFE) can be challenging.
Purpose:
- To evaluate the clinical aspects, evolution, and prognosis of dilated cardiomyopathy (DCM) in infants and children.
- To analyze differences in presentation and outcomes between infants and older children with DCM.
- To assess the diagnostic accuracy of differentiating between EFE and IM in pediatric patients.
Summary:
- A retrospective study of 38 pediatric patients (22 infants, 15 older children) with DCM revealed dyspnea as the predominant symptom in both groups.
- In infants, the diagnostic hypotheses included nonspecific myocarditis (IM), endocardial fibroelastosis (EFE), and idiopathic DCM (IDCM). Older children also presented with similar diagnostic considerations.
- The prognosis for infants with DCM, including those suspected of EFE, appeared less adverse than anticipated. Children over two years with DCM demonstrated a good prognosis. Differentiating EFE from IM proved difficult, suggesting IM may be more prevalent in younger infants.
Impact:
- The findings suggest that pediatric DCM, particularly in older children, may have a more favorable prognosis than previously assumed.
- This study highlights the diagnostic challenges in differentiating between EFE and IM, indicating a potential underestimation of IM incidence in infants.
- Improved understanding of DCM in pediatric populations can lead to refined diagnostic and therapeutic strategies, ultimately improving patient outcomes.
Purpose:
The evaluation of the clinical aspects of the dilated cardiomyopathy (DCM) in infants and children regarding, mainly, to the evolution and prognostic of this disease.
Patients And Methods:
38 patients divided in two groups: A) 22 infants till 22 (11.60 +/- 6.50) months of age, 15 female, and B) 15 children of 2 to 12 years of age (5.23 +/- 3.13) the majority males (10). A retrospective study was carried out based on the data from the patients's records. It was performed, in all the cases, a clinical, electrocardiographic, echocardiographic (M module and two dimensional echocardiography) and radiologic evaluation.
Results:
The dyspnea on exercise (included sucking) was the predominant symptom in 15 (65.22%) patients of the A group and 10 (66.67%) of the B group followed by perilabial cyanosis in 7 (30.43%) and 6 (40%) patients, respectively. In the A group the clinical diagnostic hypothesis was inspecific myocarditis (IM) in 12 (52.17%), endocardial fibroelastosis (EFE), in 8 (34.79%), and "idiopathic" dilated cardiomyopathy (IDCM) in 3 (13.04%). In the B group to the diagnostic conclusion of myocarditis was made in 10 patients (66.67%)--5 of them IM--EFE in 3 (20%); and IDCM in 2 (13.33%). The average time of evolution was 5.48 months in the A group and 18.56 in the B group. In the A group the evolution was excellent in 3 (3.04%), good in 10 (43.46%), stable in 2 (8.70%) and bad in 1 (4.35%). In the B group, excellent in 8 (53.33%), good in 2 (20%) stable in 1 (6.67%). No bad evolution in this group. There was a decrease in the A group (4.34%); 6 patients in this group (26.09%) and 3 (20%) of the B group interrupt the follow-up.
Conclusion:
1) The prognosis of infants with DCM including those with the diagnostic hypothesis of EFE seems to be less adverse than it could be supposed to be; 2) the prognostic in children with the diagnosis of DCM established above 2 years of age seems to be good; 3) the differential clinical diagnosis between EFE and IM is difficult and with no accuracy; 4) it is possible that the IM could be more prevalent in infants till 6 months of age than we suppose it was.