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Pediatric Diastolic Heart Failure: Clinical Features Description of 421 Cases
Bo Pan1,2, Di Hu3, Huichao Sun1
1Department of Cardiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
Insights
Pediatric diastolic heart failure (DHF) differs from adult HF, with congenital heart defects being a primary cause in children. B-type natriuretic peptide (BNP) has limited diagnostic value for pediatric DHF.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Heart Failure Pathophysiology
Background:
- Pediatric heart failure (HF) presents differently than in adults.
- Diastolic heart failure (DHF) in children is underreported, necessitating research into its characteristics.
Purpose of the Study:
- To summarize the causes, clinical features, laboratory findings, and treatment outcomes of pediatric diastolic heart failure (DHF).
- To compare DHF with systolic heart failure (SHF) in children.
Main Methods:
- A retrospective single-center study included 421 pediatric DHF cases and 42 SHF cases.
- Data collected between 2006 and 2014, focusing on diagnosis, symptoms, lab tests, and treatment response.
Main Results:
- Pediatric DHF patients were significantly younger (1.89 years) than SHF patients (4.65 years).
- Congenital heart malformations were the leading cause of DHF (53.4%), while cardiomyopathy dominated SHF (57.1%).
- Tachypnea and hepatomegaly were common symptoms; B-type natriuretic peptide (BNP) showed limited diagnostic utility for DHF.
Conclusions:
- Pediatric DHF and SHF exhibit distinct etiologies, clinical presentations, and prognoses.
- B-type natriuretic peptide (BNP) levels have limited diagnostic value for pediatric DHF.
- Further large-scale, multicenter studies are needed to advance understanding and management of pediatric DHF.
Background And Aim:
Heart failure in children differs substantially from the adult population. Clinical characteristics of pediatric diastolic heart failure has rarely been reported. In this study, we aimed to summary the causes, clinical features, lab tests, and treatment effect of pediatric diastolic heart failure.
Methods:
This study was a single center, retrospective study conducted in Children's Hospital of Chongqing Medical University. Children who were diagnosed with diastolic heart failure (DHF) without systolic heart failure (SHF) between 2006 and 2014 were included. Meanwhile, SHF (without DHF) cases were also collected from 2013 to 2014.
Results:
A total of 421 DHF and 42 SHF cases were included. The average age of pediatric DHF was 1.89 ± 3.29 years old, significant younger than that of SHF (4.65 ± 4.90). The top three cardiovascular causes of DHF were complex congenital heart malformations (53.4%), simple congenital heart defect (15.7%), and cardiomyopathy (7.4%). Alternatively, number of cardiomyopathy cases (57.1%) ranked first in SHF group. Simple congenital heart diseases (CHDs) rarely caused SHF. The most common symptom and sign were tachypnea and hepatomegaly in pediatric HF. Symptoms like cyanosis, feeding difficulty, be fidgety, pale, fatigue, and edema were valuable in differential diagnosis of DHF and SHF in children. B-type natriuretic peptide (BNP) increase was found in 36.9% of DHF children, and 60% in SHF patients. Sensitivity of BNP greater than 100 pg/ml in diagnosis of DHF was 0.37, and specificity of it was 0.86. Diastolic function indicators, such as E/A (early wave/late wave) ratio, IVRT (isovolumic relaxation time) were significant recovered after treatment in DHF patients. Less therapeutic benefits were achieved in children with cardiomyopathy induced DHF, in compared with non-cardiomyopathy patients.
Conclusion:
Pediatric DHF and SHF were largely different in primary causes, clinical symptoms and signs and short-term prognosis. There was a limit diagnostic value of BNP with 100 pg/ml as cut-off value in pediatric DHF. Larger, multicenter studies of pediatric DHF are required in the future.
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