Acute Heart Failure with Systolic Dysfunction in Paediatric Patients: Aetiology, Risk Factors, and In-hospital Prognosis.

Abstract

Background: Paediatric acute heart failure (AHF) differs from adult cases, and less numerous population limits research aimed at improving clinical practice and prognosis.

Aims: We aimed to evaluate outcomes and prognostic factors in the paediatric population of AHF patients with left ventricular ejection fraction (EF) <50%, or systemic right ventricular fractional area change <40%.

Methods: This single-centre retrospective cohort study included 162 consecutive paediatric patients hospitalised for new-onset AHF with systolic dysfunction or the first exacerbation with reported systolic dysfunction of chronic heart failure (CHF). Patients were categorized into two subgroups: those with >5% improvement in EF on follow-up echocardiography before discharge (n=115) and those with either EF deterioration, ≤5% EF improvement, or death during hospitalisation (n=47).

Results: The study contained 58% males and 42% females. The median age was 1 (IQR 0-8) year, 14 (IQR 2-101) months. The mortality rate was 12.3%. AHF aetiologies included congenital heart defects (51.2%), cardiomyopathy (20.4%), infections (14.2%), arrhythmias (11.7%), and others (2.5%). Our study demonstrated independent factors of worse outcomes: cardiomyopathies aetiology [OR 2.762 (1.210-6.307)], older age [OR 1.006 (1.000-1.011)], and factors of better prognosis: infective aetiology [OR 0.083 (0.010-0.664)], higher EF [OR 0.953 (0.905-0.999)], SpO2 [OR 0.951 (0.905-0.992)]. In contrast to CHF exacerbation, de novo AHF had better outcomes (p=0.014).

Conclusions: AHF with systolic dysfunction in children has an unfavourable prognosis, however most patients improved during hospitalisation. In our study, cardiomyopathy aetiology predicted worse outcomes. In turn, infective aetiology, younger age, higher EF, and SpO2 were independent factors of better prognosis.