Abstract 13127: Prognostic Value of Hemodynamic Profiles in Children With Dilated Cardiomyopathy Listed for Heart Transplantation
Congestion is the primary hemodynamic abnormality in most adults in chronic heart failure. Hemodynamic abnormalities have not been systematically evaluated in pediatric heart failure. We sought (1) to describe hemodynamic profiles assessed at heart transplant (HT) evaluation in children with dilated cardiomyopathy (DCM) listed for HT and, (2) to assess the association of these profiles with post-listing outcomes.
Methods: We identified all US children with DCM listed for HT during 2000-2010 with available pulmonary capillary wedge pressure (PCWP) and cardiac index (CIx) data. Children on a ventilator or mechanical support at listing were excluded. CIx (>2.2 l/min/m2 defined as warm, ≤ 2.2 defined cold) and PCWP (>18 mm Hg defined as wet, ≤ 18 defined dry) were used to describe 4 hemodynamic profiles: warm-dry, warm-wet, cold-dry and cold-wet. The primary outcome was death on the wait-list or removal from the wait-list due to deterioration within 1-yr and was analyzed using Cox regression.
Results: Of 476 children analyzed, there were 248 (52%) children with PCW>18 mm Hg and 176 (37%) children with CIx≤2.2 l/min/m2. Overall, 173 (36%) children were warm-dry, 127 (27%) were warm-wet, 55 (12%) were cold-dry and 121 (25%) were cold-wet. Warm-dry children were younger than the other 3 groups. Cold-dry and cold-wet children had higher pulmonary vascular resistance (median 4.8 and 4.7 Wood Units, respectively) compared to warm-dry and warm-wet children (median 2.6 and 3.1, respectively, P<0.001). Overall, 32 (6.7%) children died on the wait-list or were de-listed due to deterioration. In analysis adjusted for listing status, cold-dry (Hazard ratio [HR] 3.5, 95% CI 1.1, 11.5, P=0.04) and cold-wet (HR 3.2, 95% CI 1.2, 8.6, P=0.02) children were at higher risk of wait-list death vs. warm-dry children; the risk in warm-wet children (HR 2.3, 95% CI 0.8, 6.6, P 0.11) did not reach statistical significance. All 4 groups were equally likely to receive HT. Post-transplant 1-yr survival was 93.5% overall and was similar in the 4 groups.
Conclusion: Children with dilated CMP with low cardiac output at HT evaluation are at higher risk of wait-list mortality, whether they are wet or dry. Hemodynamic profiling may improve risk-stratification of children with DCM being listed for HT.
- © 2013 by American Heart Association, Inc.