Background Anemia is highly prevalent and affects morbidity and mortality in adults with acquired heart disease. However, its role in children with acyanotic congenital heart disease (CHD) is unclear.Objective To assess anemia and other potential prognostic factors of congestive failure in children with left-to-right shunt acyanotic CHD. MethodsWe conducted a case-control study in the Pediatric Cardiology Clinic, Dr. Sardjito Hospital from January to December 2017 in children with left-to-right shunt acyanotic CHD. The case and control groups consisted of subjects with and without heart failure, respectively. Anemia was defined as hemoglobin concentration <11 g/dL. Measured outcome was the prevalence of congestive heart failure, as determined by the Ross criteria. Anemia, defect type, defect size, age at diagnosis, and gender were analyzed by logistic regression analysis as potential predictive factors of heart failure. ResultsOf 100 children with left-to-right shunt acyanotic CHD, 50 had heart failure (the case group) and 50 did not (the control group). The prevalence of anemia was 45%. Multivariable logistic regression revealed that defect size was the most significant factor for predicting heart failure, with adjusted OR 7.6 (95%CI 2.5 to 22.8) for moderate shunts and 21.1 (95%CI 6.8 to 65.4) for large shunts. Anemia, type of defect, age of diagnosis, and gender were not statistically significant factors for predicting outcomes.Conclusion Anemia is not a significant, prognostic factor for heart failure in children with left-to-right shunt acyanotic CHD. However, moderate and large shunts in children with left-to-right shunt acyanotic CHD are predictive of the occurrence of congestive heart failure. [Paediatr Indones. 2019;59:63-6; doi: http:// dx.
Background Left-to-right shunting in acyanotic congenital heart disease (CHD) is the most common type of defect in childhood heart disease. Limited access to specialist health services causes delays in CHD management. In limited resource settings, identification of factors that influence the occurrence of pulmonary hypertension is important in order to decide which patients should be prioritized for defect closure to prevent further complications. Objective To determine predictive factors of pulmonary hypertension after a left-to-right shunt CHD diagnosis. Methods This retrospective cohort study included children aged 1 month to 17 years with isolated atrial septal defect, or ventricular septal defect, or patent ductus arteriosus. Potential predictors studied were iron deficiency anemia, mitral regurgitation, pneumonia, and heart failure. Bivariate analysis was done with Chi-square test and multivariate analysis was done with Cox regression to determine the hazard ratio. Results Pulmonary hypertension occurred in 68 of 176 subjects. Iron deficiency anemia, mitral regurgitation, and pneumonia were not predictives of pulmonary hypertension. However, heart failure was a significant predictive factor for pulmonary hypertension, with a hazard ratio of 4.1 (95%CI 2.2 to 7.5; P=0.001). Conclusions Heart failure is a predictive factor of pulmonary hypertension in children with left-to-right shunting in acyanotic CHD.
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