Dilated cardiomyopathy and thrombo-embolism

Günthard, Joëlle; Stocker, Florian; Bolz, D.; Jäggi, E; Ghisla, Renzo; Oberhänsli, I; Wyler, F

doi:10.1007/s004310050541

Cited by 45 publications

(42 citation statements)

References 26 publications

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“…Arrhythmia, thromboembolism and sudden death are common and may occur at any stage of the disease. [5][6][7] Within the pediatric group, IDCM is responsible for a large number of consultations and hospitalizations for HF not associated with congenital heart disease and, among under two-year-olds it is responsible for up to 29% of consultations. 8 It results in a high mortality rate, with figures in published literature varying from 16% 9 at 10 years to rates as high as 49% 10 , 66% 11 and even 80% 12 at 5 years.…”

Section: Introductionmentioning

confidence: 99%

O impacto da desnutrição na cardiomiopatia dilatada idiopática na infância

Azevedo

Filho

Santos

et al. 2004

J. Pediatr. (Rio J.)

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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.

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Section: Introductionmentioning

confidence: 99%

O impacto da desnutrição na cardiomiopatia dilatada idiopática na infância

Azevedo

Filho

Santos

et al. 2004

J. Pediatr. (Rio J.)

View full text Add to dashboard Cite

show abstract

“…However, specific data on thrombosis and thromboembolism and their impact on outcomes are lacking, and limited to case reports and a single retrospective study (7)(8)(9). The overall period prevalence of thrombosis found in the present study was 14%.…”

Section: Discussionmentioning

confidence: 60%

“…The overall period prevalence of thrombosis found in the present study was 14%. The reported prevalence of thromboembolism in children with DCM ranges from 4% to 16% (1,4,9), with evidence to suggest that it may be as high as 43% to 57% at autopsy (1,16,17). There are multiple factors that have been proposed that may predispose patients with cardiomyopathy to thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnostic features described in adults (27), which have been applied and confirmed in children (8), include location of the thrombus most frequently in the ventricular apex, the presence of distinct margins with an acoustic density different from the underlying myocardium, free motion of the intracavitary margin of the thrombus, variation in thrombus characteristics noted on serial examinations and abnormal wall motion of the associated myocardial wall segment. It has been found that transesophageal echocardiography is superior to transthoracic echocardiography in the detection of intracardiac thrombosis and may be indicated when no intracardiac thrombosis is detected by transthoracic echocardiography in the presence of clinical thromboembolism (9). The main limitation of transesophageal echocardiography is the requirement of general anesthesia in children and the difficulty of examining the cardiac apex, which is a common location for thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…Systemic anticoagulation with intravenous heparin therapy or oral anticoagulants is indicated when there is evidence of a thromboembolic event and the presence of intracardiac thrombosis. In these situations, antiplatelet therapy alone is inadequate, because it will not promote resolution of the thrombus (8), unlike with systemic anticoagulation (20), which is also felt to be effective in the prevention of thromboembolism (9,20). Clinical thromboembolism without documented intracardiac thrombosis may also warrant anticoagulant therapy.…”

Section: Discussionmentioning

confidence: 99%

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