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Original Research

Program: Section on Cardiology and Cardiac Surgery

P2A164: Stroke Distance: A Simple but Useful Doppler Prognostic Index in Children with Dilated Cardiomyopathy Admitted with Heart Failure

Saturday, October 21, 2023
4:30 PM – 5:30 PM US EDT
Location: Walter E. Washington Convention Center, Exhibit Hall A
Poster Presentation
Background: Dilated Cardiomyopathy (DCM) in children is associated with death or transplantation in 50% in 5 years following diagnosis. Prognosis is worse among those who present with congestive heart failure (CHF) symptoms. Stroke distance (SD), a simple Doppler measure, has been shown to be useful in adults with heart failure. Our aim was to evaluate the prognostic utility of SD in children with DCM who presented with symptoms of CHF.

Methods: This was a single center retrospective review of the first diagnostic echocardiogram of DCM patients ≤ 2 years of age with symptoms of CHF. Patients with known DCM on medications, with incomplete data, on pulmonary vasodilator, or pericardial effusion were excluded. A single reader blinded to clinical data evaluated the echocardiograms. SD, a product of velocity time integral (VTI) and heart rate (HR), was obtained for right (RV) and left (LV) ventricle. VTI was measured from an apical 5-chamber view with the pulse Doppler just below the aortic valve (LV) leaflet or just after the pulmonary valve (RV). Our primary outcome was death within one year of presentation. Echocardiographic measures were compared between groups with and without the primary outcome using student t-test and Chi-square test.

Results: Our study cohort (n=35), 13 (37%) of whom were males, had a mean (SD) age of 8.1 (1.0) months. Eleven (31%) required ECMO support, 5 (14%) received LV assist device, 12 (34%) underwent transplantation and 11 (31%) died within one year. Out of 11 patients who died 2 patients had heart transplant. Children who died were significantly older at presentation but had comparable weight, and body surface area, compared to survivors. LV and RV SD indexed were both significantly lower in the group that died, compared to survivors. The ROC of various parameters are shown in Table 2.

Conclusion: Indexed stroke distance for LV and RV were significantly lower on the initial echocardiogram among children with DCM who died within a year of diagnosis. However, due to small sample size, ROC areas were modest and cutoff values with reasonable accuracy could not be obtained. Further investigation into the prognostic utility of this simple Doppler measure in larger multicenter cohorts of children with symptomatic DCM is warranted