Acute heart failure with systolic dysfunction in paediatric patients: aetiology, risk factors, and in-hospital prognosis.

IF 4.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Heart Journal: Acute Cardiovascular Care Pub Date : 2025-08-07 DOI:10.1093/ehjacc/zuaf049

Kamila Kurkiewicz-Sawczak, Filip Sawczak, Filip Baszkowski, Kinga Walska-Świerc, Malwina Baturo, Weronika Pelczar-Płachta, Dominika Wysocka, Marta Kałużna-Oleksy, Waldemar Bobkowski

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引用次数: 0

Abstract

Aims: Paediatric acute heart failure (AHF) differs from adult cases, and less numerous population limits research aimed at improving clinical practice and prognosis. 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 and results: This single-centre retrospective cohort study included 162 consecutive paediatric patients hospitalized 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 EF deterioration, ≤5% EF improvement, or death during hospitalization (n = 47). The study contained 58% males and 42% females. The median age was 1 [interquartile range (IQR) 0-8] year, 14 (IQR 2-101) months. The mortality rate was 12.3%. Acute heart failure 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 [odds ratio (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)], oxygen saturation (SpO2) [OR 0.951 (0.905-0.992)]. In contrast to CHF exacerbation, de novo AHF had better outcomes (P = 0.014).

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

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小儿急性心力衰竭合并收缩功能障碍：病因、危险因素和住院预后。

背景：儿科急性心力衰竭（AHF）不同于成人病例，由于人数较少，限制了旨在改善临床实践和预后的研究：这项单中心回顾性队列研究纳入了162名连续住院的新发AHF收缩功能障碍或慢性心力衰竭（CHF）收缩功能障碍首次加重的儿科患者。患者被分为两个亚组：出院前超声心动图随访EF改善>5%的患者（115人）和EF恶化、EF改善≤5%或住院期间死亡的患者（47人）：研究中男性占58%，女性占42%。中位年龄为1（IQR 0-8）岁，14（IQR 2-101）个月。死亡率为 12.3%。AHF病因包括先天性心脏缺陷（51.2%）、心肌病（20.4%）、感染（14.2%）、心律失常（11.7%）和其他（2.5%）。我们的研究显示了预后较差的独立因素：心肌病病因[OR 2.762 (1.210-6.307)]、年龄较大[OR 1.006 (1.000-1.011)]，以及预后较好的因素：感染性病因[OR 0.083 (0.010-0.664)]、较高的 EF [OR 0.953 (0.905-0.999)]、SpO2 [OR 0.951 (0.905-0.992)]。与CHF恶化相比，新发AHF的预后更好（P=0.014）：结论：儿童心房颤动伴收缩功能障碍的预后较差，但大多数患者在住院期间病情有所好转。在我们的研究中，心肌病病因预示着较差的预后。而感染性病因、年龄较小、EF值较高和SpO2则是预后较好的独立因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Heart Journal: Acute Cardiovascular Care Medicine-General Medicine

CiteScore

8.50

自引率

4.90%

发文量

325

期刊介绍： The European Heart Journal - Acute Cardiovascular Care (EHJ-ACVC) offers a unique integrative approach by combining the expertise of the different sub specialties of cardiology, emergency and intensive care medicine in the management of patients with acute cardiovascular syndromes. Reading through the journal, cardiologists and all other healthcare professionals can access continuous updates that may help them to improve the quality of care and the outcome for patients with acute cardiovascular diseases.