Abstract 20302: Ventricular Arterial Coupling: A Novel Echocardiographic Risk Factor for Disease Progression in Pediatric Dilated Cardiomyopathy
Introduction: A higher (VA) coupling ratio measured non-invasively has been well described in adult heart failure patients and is associated with worse heart failure prognosis and response to treatment, largely due to increases in arterial elastance. There is no data regarding the importance of VA coupling in pediatric patients with heart failure
Hypothesis: A higher VA coupling ratio will be associated with worse outcomes in pediatric patients with dilated cardiomyopathy (DCM).
Methods: Demographic, clinical and echocardiographic (echo) data (including ventricular volumes, arterial elastance and LV elastance) were obtained in children with DCM. The association of VA coupling ratio with worse outcome (mechanical circulatory support, transplant, or death) was assessed.
Results: Echos from 29 patients with DCM (23 idiopathic, 3 Duchenne, 3 other) were reviewed. Mean age at presentation was 6±7 years, mean age at echo was 10±4 years. At the time of echo, 9 patients were hospitalized for initiation of inotropic therapy, 20 were out of hospital. Outcome events occurred in 12/29 patients (41%) at a mean of 2 ±1.7 years after echo. Patients with worse outcomes had a higher NYHA class than those without (3.5 ±0.9 vs. 1.7 ±1.3, respectively p=0.001), lower LV elastance (1.03 ± 0.64 vs. 1.95 ± 0.79, respectively p= 0.002), higher arterial elastance (3.53 ±1.57 vs. 2.74 ±1.27, respectively p= 0.001), and a higher VA coupling ratio ( 4.4 ± 2.6 vs 1.9 ± 1.8, respectively p =0.001, Figure 1). Increased VA coupling was significantly associated with worse outcome (AUC =0.858, Figure 1)
Conclusion: A higher VA coupling ratio is significantly associated with worse outcome in pediatric patients with DCM. Unlike adult data, this mechanism is driven not only by an increase in arterial elastance but also a decrease in ventricular elastance. VA coupling may provide insight into the mechanisms of heart failure in pediatric DCM and identify potential targets for therapy.
Author Disclosures: C.A. Capone: None. J. Lorenzo: None. B. Tria: None. J.M. Lamour: None. D.T. Hsu: None. J. Mahgerefteh: None.
- © 2016 by American Heart Association, Inc.