Prognostic significance of tissue Doppler imaging-derived myocardial performance index in pediatric patients with dilated cardiomyopathy

• Type of Material: Article
• Authors: Lydia K. Wright, Emory University; Falon McGaughy, Childrens Healthcare Atlanta; Michael Kellerman, Emory University; William Border, Emory University; Ritu Sachdeva, Emory University
• Language: English
• Date: 2019-11-10
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 John Wiley & Sons, Inc. All rights reserved
• Final Published Version (URL): http://dx.doi.org/10.1111/petr.13613
• Title of Journal or Parent Work: Pediatric Transplantation
• Volume: 24
• Issue: 1
• Start Page: e13613
• End Page: e13613
• Grant/Funding Information: None declared
• Keywords: Science & Technology; Children; Heart failure; Pulsed wave doppler; cardiac function; echocardiography; Ventricular TEI index; Life Sciences & Biomedicine; Predictors; Transplantation; cardiomyopathy; heart transplant; Dysfunction; Pediatrics; pediatric; Echocardiography
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery; Health Sciences, Human Development

Abstract

TDI–MPI has been shown to predict cardiovascular mortality in adults; there are a paucity of data on its use in children. We sought to determine the prognostic significance of TDI-MPI at time of DCM diagnosis in children. Patients aged ≤18 years diagnosed with DCM were included along with age- and sex-matched controls. Echo at diagnosis was analyzed to obtain standard measures of LV function, PW-MPI, and septal and LV free wall TDI-MPI. Survival analysis was used to assess the time to composite outcome of death, VAD, or transplant, stratified by TDI-MPI z-score. The study included 79 patients with DCM and 79 controls. During a median follow-up of 182 days (IQR 41-815 days), 16 underwent VAD placement, 21 underwent cardiac transplant, 6 died, and 36 had event-free survival. The median septal TDI-MPI for cases was 0.70 for patients with DCM vs 0.45 for controls (P <.001). Those with septal TDI-MPI z-scores ≥2 develop events significantly earlier than those with z-score <2 (P =.014). In multivariable analysis, TDI-MPI z-score ≥2 was significantly associated with poor outcomes (HR 2.12, 95% CI 1.06-4.23). TDI-MPI can be reliably performed in pediatric patients with DCM. A TDI-MPI z-score ≥2 at diagnosis may be associated with earlier poor outcome. Further studies evaluating the use of TDI-MPI in longitudinal follow-up of patients with DCM may be helpful in refining its clinical use.