Pediatric heart failure classification based on left ventricular ejection fraction

Area of Science:

• Pediatric Cardiology
• Cardiovascular Research
• Clinical Classification

Background:

• Left ventricle ejection fraction (LVEF) is underutilized in pediatric heart failure (PHF) classification.
• Current PHF classifications lack detailed stratification based on LVEF.
• Understanding LVEF's role is vital for accurate PHF diagnosis and management.

Purpose of the Study:

• To categorize PHF based on LVEF.
• To investigate the clinical significance of LVEF in PHF.
• To identify factors influencing HF with improved EF (HFimpEF) and in-hospital mortality.

Main Methods:

• Categorization of PHF patients into HF with reduced EF (HFrEF), HF with mildly reduced EF (HFmrEF), and HF with preserved EF (HFpEF) based on LVEF.
• Comparative analysis of clinical data across LVEF groups.
• Analysis of factors associated with HFimpEF and in-hospital death.

Main Results:

• The majority of pediatric HF patients (66.3%) presented with preserved LVEF.
• Significant differences in age, B-type natriuretic peptide (BNP) levels, Ross classification, and E/A ratio were observed across LVEF groups.
• Younger age, lower BNP, less cardiac dysfunction, and normal E/A ratio correlated with higher LVEF.
• Primary disease prevalence varied significantly among HFpEF, HFmrEF, and HFrEF groups.
• Lower LVEF patients received more aggressive medical treatment, excluding vasoactive drugs.
• Congenital heart disease in HFrEF was linked to a higher likelihood of HFimpEF.
• Sepsis, renal insufficiency, and abnormal E/A ratio were identified as risk factors for in-hospital death.

Conclusions:

• LVEF serves as an essential and effective indicator for classifying and managing PHF.
• LVEF stratification provides valuable insights into clinical features and prognosis in pediatric heart failure.
• Identifying risk factors for mortality aids in targeted interventions for critically ill pediatric HF patients.