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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
[Age-stratified analysis of left ventricular ejection fraction threshold heterogeneity for heart failure with
1Department of Cardiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Children and Adolescents' Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Children's Important Organ Development and Diseases of Chongqing Municipal Health Commission, National Clinical Key Cardiovascular Specialty, Chongqing 400014, China.
Insights
Pediatric heart failure with preserved ejection fraction (HFpEF) diagnosis may require age-specific left ventricular ejection fraction (LVEF) thresholds. A 55% LVEF threshold is suggested for children under 12, and 50% for older children.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Heart Failure Diagnostics
Background:
- Heart failure with preserved ejection fraction (HFpEF) diagnosis in children is challenging due to a lack of age-adapted criteria.
- Current diagnostic thresholds for left ventricular ejection fraction (LVEF) are primarily based on adult data.
Purpose of the Study:
- To investigate age-specific left ventricular ejection fraction (LVEF) diagnostic thresholds for pediatric heart failure with preserved ejection fraction (HFpEF).
- To determine if LVEF thresholds vary across different age groups in children with heart failure.
Main Methods:
- A multicenter retrospective cohort study analyzed 1,018 pediatric heart failure patients.
- Patients were stratified by LVEF (<50%, 50%-<55%, ≥55%) and age (cutoffs at 9, 10, 11, 12, 13 years).
- Statistical analyses, including multivariable linear regression, were used to assess associations between LVEF categories and cardiac structural parameters.
Main Results:
- Age-stratified analyses revealed differences in cardiac structural parameters (LVESD, left atrial diameter) based on LVEF categories and age cutoffs.
- LVEF correlated with LVESD in children ≥10 and ≥11 years, and with left atrial diameter in children <12 years.
- Significant clinical differences were observed among LVEF groups, including age, symptoms, and underlying cardiac conditions.
Conclusions:
- Age-related heterogeneity exists in LVEF thresholds for diagnosing pediatric HFpEF.
- An LVEF threshold of 55% is recommended for children younger than 12 years.
- An LVEF threshold of 50% may be considered for children aged 12 years and older, aligning with adult criteria.
Abstract:
Objective: To explore age-adapted left ventricular ejection fraction (LVEF) diagnostic thresholds for heart failure with preserved ejection fraction (HFpEF) in children. Methods: In this multicenter retrospective cohort study, children with chronic heart failure were selected from 3 546 hospitalized pediatric heart failure patients across 30 medical centers in 20 provinces, autonomous regions and municipalities in China from January 2013 to December 2022. Children were divided into 3 groups based on LVEF:<50%, 50%-<55%, and ≥55%. Age-stratified analyses were performed using cutoffs at 9, 10, 11, 12, and 13 years of age. Intergroup comparisons were conducted using the chi-square test or Fisher's exact test, Wilcoxon rank-sum test or Kruskal-Wallis test. Multivariable linear regression was used to analyze the independent association between LVEF categories and cardiac structural parameters. Results: A total of 1 018 pediatric patients were included in the analysis. Among them, 527 (51.8%) were male and 491 (48.2%) were female, with an age of 1.2 (0.4, 7.1) years. There were 447 children in LVEF <50% group, 62 children in 50%-<55% group, and 509 children in ≥55% group. Statistical differences in baseline clinical characteristics were observed among the 3 groups, including age, heart rate, respiratory symptoms, systemic congestion symptoms, congenital heart disease, cardiomyopathy cardiovascular events, growth retardation (all P<0.05). Age-stratified analysis showed that when using 9, 10 and 11 years of age as cutoffs, left ventricular end-systolic diameter (LVESD) differed between the LVEF <50% and 50%-<55% groups in children aged at or above the respective cutoff (all P<0.05). When using 12 and 13 years of age as the cutoff, left atrial diameter differed between the LVEF 50%-<55% and ≥55% groups in children below 12 and 13 years of age (both P<0.05). After adjustment for covariates using multivariable linear regression, when using 10 and 11 years of age as the cut-offs, LVEF were correlated with LVESD in both children aged ≥10 years and those aged ≥11 years (β=11.62 and 10.94,95%CI 2.38-20.85 and 1.32-20.56, P=0.018 and 0.029). And when using 12 years of age as the cut-offs, LVEF was correlated with left atrial diameter in children aged <12 years of age (β=-1.82,95%CI -3.29--0.35,P=0.015). Conclusion: Age-related heterogeneity may exist in the LVEF thresholds for pediatric HFpEF, an LVEF threshold of 55% is recommended for children younger than 12 years, whereas 50% consistent with adult criteria, may be considered for those aged 12 years or older.
