Clinical Analysis Of 109 Children With Cardiomyopathy And Study Of Factors Affecting The Short-Term Prognosis Of Left Ventricular Systolic Dysfunction Cardiomyopathy

Part 1:Clinical analysis of 109 children with cardiomyopathyObjectiveThe aim of this study is to retrospectively analyze the clinical data of cardiomyopathy in children treated by our hospital between October,2010 and December,2018 and the prognosis conditions in the follow-up,to analyze its clinical characteristics and deepen the understanding of cardiomyopathy.MethodsThe cardiomyopathy cases hospitalized at Children's Hospital of Soochow University between October 2010 and December 2018 were retrospectively analyzed,the clinical data,such as age,gender,clinical symptoms,ECG and cardiac ultrasound etc.were collected.Modified Ross score(for the infants)and cardiac functional grading(for the elderly children)were adopted for evaluating the admitting cardiac function,the clinical characteristics were concluded and summarized.Outpatient or phone-call follow-up was employed for the discharge cases,heart transplantation or death was the outcome event;SPSS22.0 software was utilized for data analysis,and the differences were statistically significant when P<0.05.ResultsA total of 109 cases were collected,including 57 males,accounting for 52.3%,and 52 females,accounting for 47.7%,the gender ratio was 1.09:1,the ages were between 1 month and 16 Years,the median age was 10.5 years old.Among them,58 cases were DCM,19 cases were NVM,17 cases were HCM,9 cases were TIC,and 4 cases were EFE,the remaining 2 cases of RCM.Most of the children had respiratory symptoms when visited,altogether 53 cases with III or IV level of cardiac function,which took up 48.6%.Respiratory tract manifestations were the initial symptoms in the majority of DCM and HCM,with 34 cases(58.6%)and 17 cases(47.1%),respectively.The HCM type had more severe cardiac insufficiency at admitting,many children had III or IV level of cardiac function,altogether 11 cases(64.7%).Almost all the 109 hospitalized children with cardiomyopathy had ecg abnormalities,including 78(71.6%)with st-t changes,5(4.6%)with abnormal Q waves,45(41.3%)with premature beats,31(28.4%)with tachycardia(excluding sinus tachycardia),and 24(22.0%)with conduction block.Fourteen patients(12.8%)had preexcitation syndrome.DCM and NVM were often associated with arrhythmias.In case statistics,more than 60%of ventricular pre-systole was concentrated in DCM,followed by NVM.The higher the degree of cardiac insufficiency in DCM,the higher the value of BNP and troponin I(?2=8.246,P<0.001;?2=3.469,P=0.023),the lower the LVEF and LVFS(?2=4.751,P=0.005;?2=5.176,P=0.003).LVEDD-Z score increased with the aggravation of cardiac insufficiency,but there was no statistically significant difference between the two groups(?2=1.329,P=0.274).The higher the DCM cardiac function level,the higher the probability of arrhythmia,but the difference was not statistically significant(x2=5.961,P=0.113).There were two cases of children died in the initial hospitalization,both of which were HCM;outpatient or phone-call follow-up was conducted among the 107 cases of discharge cases,87 cases had fulfilled the follow-up,the median follow-up time was 14 months(between one month and eight years),there were 8 cases of death and one case of DCM had heart transplantation.The cardiac functions of 9 TIC cases basically returned to normal after recovering to the sinus rhythm by given medication or radiofrequency ablation surgery.The overall 1-year survival rate of cardiomyopathy was 92.5%,the 3-year and 5-year survival rate was 91.5%;the 1-year survival rate of DCM was 96.5%,the 3-year and 5-year survival rate was 93.1%.The 1-year survival rate of HCM was 58.8%,the 5-year survival rate was 58.8%.Conclusion1.The overall incidence of childhood cardiomyopathy in our hospital is higher than that of females.The incidence of small age is mostly,and more than 50%of children suffer from respiratory or digestive discomfort,accompanied by cardiac dysfunction.2.DCM is the most common type in the children cardiomyopathy,the predilection age is within one year,almost all of the DCM ECG may present abnormal manifestations.3.Cardiomyopathy characterized by cardiac diastolic insufficiency,such as HCM has severe clinical manifestation and higher rate of death.4.The early diagnosis and treatment is the critical point in TIC,after undergoing active medication or radiofrequency ablation surgery for recovering the sinus rhythm,partial or complete cardiac insufficiency manifestations may recover to normal conditions,these cases belong to the reversible cardiomyopathy.Part 2:Study of factors affecting short-term prognosis of left ventricular systolic dysfunction in cardiomyopathyObjectiveTo analyze the factors affecting short-term prognosis of children with left ventricular systolic dysfunction cardiomyopathy,and to explore the relationship between initial hemogram Neutrophil-to-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),BNP level and short-term prognosis.MethodsThe data of 52 patients with left ventricular systolic dysfunction were retrospectively analyzed,including age,sex,electrocardiogram,echocardiogram,hemogram and BNP level.SPSS22.0 software was used for data analysis,and logistic regression analysis was conducted for factors with univariate P<0.05,and ROC curve analysis was conducted for variables with P<0.05 in logistic.P<0.05 was considered statistically significant.ResultsAmong the 52 cases of left ventricular systolic dysfunction cardiomyopathy,21 cases improved and 31 cases did not improve after 6 months of optimal treatment.The number of st-t changes(x2=4.48,P=0.034),PLR(t=3.92,P=0.005),NLR(t=5.143,P=0.003)and BNP value(t=2.983,P=0.01)in the improved group were significantly lower than those in the non-improved group.Initial LVEF value(t=23.616,P=0.025)and lymphocyte count(t=1.985,P=0.027)in the improvement group were significantly higher than those in the non-improvement group.Multivariate logistic regression analysis showed that BNP(odds ratio(OR))=0.996,95%confidence interval(CI)0.992-1,P=0.015),NLR(OR)=0.319,95%(CI)0.133-0.764,P<0.001)were independent risk factors for the prognosis of left ventricular systolic dysfunction cardiomyopathy.The ROC curve of NLR value showed that the area under the curve(AUC)was 77.6%(HF 95%:0.651-0.900).P=0.001),so the best cut-off point to predict the effect on prognosis was 1.87(sensitivity:51.6%and specificity:95.2%).The area under the curve(AUC)of BNP value ROC curve was 74%(HF 95%:0.599-0.882).P=0.004),so the best cutoff point to predict the effect of prognosis is 164pg/ml(sensitivity:64.5%and specificity:81.0%).Conclusion1.ST-T changes,lymphocyte count,PLR,and newly diagnosed LVEF are associated with prognosis of left ventricular systolic dysfunction.2.BNP and NLR ratio may be independent predictors of prognosis for left ventricular systolic dysfunction.