O impacto da desnutrição na cardiomiopatia dilatada idiopática na infância

Abstract

Objective: To analyze the prognostic value of malnutrition in children with idiopathic dilated cardiomyopathy.Methods: This is a retrospective study of 165 patients with idiopathic dilated cardiomyopathy, diagnosed from September 1979 to March 2003. It analyzed the following variables: gender, age, previous viral illness in the preceding 3 months, functional class according to the New York Heart Association (NYHA), evaluation of nutritional status (normal vs malnutrition), percentile and standard deviation (z index) of weight. Weight was measured 744 times during the first 72 months, 93 during the first month. Statistical analysis was performed by chi-squared, Student t test and analysis of variance for repeated measures (ANOVA). Ninety-five percent confidence intervals (CI95) and odds ratios (OR) were calculated. An alpha value of 0.05 and beta of 0.80 were used.Results: Mean age at presentation was 2.2±3.2 years with higher incidence in those younger than 2 years (75.8%-CI95 = 68.5% to 82.1%) (p < 0.0001). NYHA classes III and IV were observed in 81.2% (CI95 = 74.4% to 86.9%) (p < 0.0001) and all 40 deaths were this group (p = 0.0008). At presentation, myocarditis occurred in 39.4% (CI95 = 31.9% to 47.3%) (p = 0.0001) and a high level of association between myocarditis and previous viral illness was observed (p = 0.0005) (OR = 3.15-CI95 = 1.55 to 6.44). Malnutrition at presentation did not influence death (p = 0.10), however progressive malnutrition was a marker for death (p = 0.02) (OR = 3.21-CI95 = 1.04 to 9.95). No significant differences weight percentiles (p = 0.15) or in z scores (p = 0.14) were observed. Observed mean weight percentiles (34.9±32.6 vs 8.6±16.0) (p < 0.0001) and z scores (-0.62±1.43 vs 2.02±1.12) (p < 0.0001) during the study period were greater among survivors. ANOVA demonstrated significant differences in weight percentile progression (p = 0.0417) and z scores (p = 0.0005) from the first month onwards. Conclusion:The evaluation of nutritional status. is easy to performer, it does not imply additional costs and should become routine for children with chronic heart failure.J Pediatr (Rio J). 2004;80(3):211-6: Dilated cardiomyopathy, children, malnutrition, heart failure.

Prognostic value of chest roentgenograms in children with idiopathic dilated cardiomyopathy

“…A idade média da apresentação foi de 2,2 anos nesta série 17 , sendo semelhante à maioria dos relatos da literatura 9,10,[18][19][20] . Entretanto, alguns autores encontraram médias superiores 8,11,21,22 .…”

“…Entretanto, alguns autores encontraram médias superiores 8,11,21,22 . Na amostra estudada, foi observada preferência do início da doença pela faixa etária inferior aos 2 anos (76,3%), comparado ao grupo > 2 anos 17 . A literatura é controversa, sendo esta observação compartilhada por alguns autores 18,23 , mas não por outros 19,24 .…”

“…A faixa etária no momento do diagnóstico não influenciou a mortalidade 17 , sendo encontrada idêntica observação na literatura [25][26][27] . Entretanto, Arola et al 9 encontraram, na população finlandesa, mortalidade maior nos menores de 1 ano de vida portadores de fibroelastose endocár-dica e nos adolescentes masculinos.…”

“…Não foi observada diferença na incidência em relação ao sexo 17 , estando este dado de acordo com a literatura [7][8][9][10][11]23,27,[29][30][31] . O sexo não influiu na mortalidade nesta série 17 , também conforme o relatado por outros autores 11,19,27 .…”

“…O sexo não influiu na mortalidade nesta série 17 , também conforme o relatado por outros autores 11,19,27 . Apesar de extensa pesquisa, não foram encontradas outras referências bibliográficas em relação à incidência e prognóstico quanto à etnia.…”