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The relationship between electrocardiographic data and mortality in children diagnosed with dilated cardiomyopathy

Abstract

The mortality causes of patients followed up due to dilated cardiomyopathy (DCM) include complications related to heart failure, ventricular arrhythmia, and transplantation. This study aims to evaluate the electrocardiographic findings of patients diagnosed with dilated cardiomyopathy and determine its relationship with mortality. The electrocardiographic, clinical, and laboratory findings of patients diagnosed with dilated cardiomyopathy between January 1, 2012, and September 1, 2018, in our university’s pediatric cardiology department were retrospectively evaluated. The electrocardiographic findings of surviving and exitus dilated cardiomyopathy patients were compared and their effect on mortality was investigated. Twelve of the total 85 patients diagnosed with dilated cardiomyopathy were deceased. According to the electrocardiographic findings of surviving and exitus patients, there was a statistically significant difference in terms of P maximum (Pmax), P dispersion (Pdis), QT dispersion (QTdis), QTc maximum (QTcmax), QTc dispersion (QTcdis), Tp-e maximum (Tp-emax), Tp-e dispersion (Tp-edis), and QRS time. Hypertrophy and ischemia findings of electrocardiography were also statistically significant. There was a statistically significant difference between the two groups according to the echocardiographic findings of left ventricular ejection fraction (LVEF), left ventricular shortening fraction (LVSF), left ventricular end-diastolic diameter (LVEDd), and left ventricular end-systolic diameter (LVESd) measurements. It is well known that children diagnosed with dilated cardiomyopathy are at greater risk of arrhythmia compared with normal children. Although previous studies have determined the relationship between mortality and a limited number of electrocardiographic findings, especially in adults, the relationship between electrocardiography findings of children diagnosed with DCM and mortality has not been investigated before in such detail, as in our study.

Conclusion: In this study, the significant difference between the electrocardiographic data of deceased and surviving dilated cardiomyopathy patients suggests that electrocardiographic data should be evaluated in detail in order to determine the low and high risk of mortality in patients with dilated cardiomyopathy.

What is Known:
Previous studies on the relationship between limited electrocardiography data of adult patients diagnosed with DCM and mortality have been determined
What is New:
ECG data has not been investigated in such detail in child DCM patients, as in our study.

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Abbreviations

DCM:

Dilated cardiomyopathy

ECG:

Electrocardiography

LVEF:

Left ventricular ejection fraction

LVSF:

Left ventricular shortening fraction

LVEDd:

Left ventricular end-diastolic diameter

LVESd:

Left ventricular end-systolic diameter

Pmax:

P maximum

Pdis:

P dispersion

QTdis:

QT dispersion

QTcmax:

QTc maximum

QTcdis:

QTc dispersion

Tp-emax:

Tp-e maximum

Tp-edis:

Tp-e dispersion

References

  1. 1.

    Jefferies JL, Towbin JA (2010) Dilated cardiomyopathy. Lancet. 375:752–762

  2. 2.

    Towbin JA, Lowe AM, Colan SD, Sleeper LA, Orav EJ, Clunie S et al (2006) Incidence, causes, and outcomes of dilated cardiomyopathy in children. JAMA. 296:1867–1876

  3. 3.

    Lipshultz SE, Sleeper LA, Towbin JA, Lowe AM, Orav EJ, Cox GF, Lurie PR, McCoy K, McDonald M, Messere JE, Colan SD (2003) The incidence of pediatric cardiomyopathy in two regions of the United States. N Engl J Med 348:1647–1655

  4. 4.

    Wilkinson JD, Landy DC, Colan SD, Jeffrey A, Sleeper LA, Orav EJ et al (2011) The pediatric cardiomyopathy registry and heart failure: key results from the first 15 years. Hear Fail Clin 6:401–413

  5. 5.

    Everitt MD, Sleeper LA, Lu M, Canter CE, Pahl E, Wilkinson JD, Addonizio LJ, Towbin JA, Rossano J, Singh RK, Lamour J, Webber SA, Colan SD, Margossian R, Kantor PF, Jefferies JL, Lipshultz SE, Pediatric Cardiomyopathy Registry Investigators (2014) Recovery of echocardiographic function in children with idiopathic dilated cardiomyopathy. J Am Coll Cardiol 63:1405–1413

  6. 6.

    Kirk R, Dipchand AI, Rosenthal DN, Addonizio L, Burch M, Chrisant M, Dubin A, Everitt M, Gajarski R, Mertens L, Miyamoto S, Morales D, Pahl E, Shaddy R, Towbin J, Weintraub R (2014) The International Society of Heart and Lung Transplantation guidelines for the management of pediatric heart failure: executive summary. J Heart Lung Transplant 33:888–909

  7. 7.

    Alvarez JA, Orav EJ, Wilkinson JD, Fleming LE, Lee DJ, Sleeper LA, Rusconi PG, Colan SD, Hsu DT, Canter CE, Webber SA, Cox GF, Jefferies JL, Towbin JA, Lipshultz SE, Pediatric Cardiomyopathy Registry Investigators (2011) Competing risks for death and cardiac transplantation in children with dilated cardiomyopathy: results from the pediatric cardiomyopathy registry. Circulation 124:814–823

  8. 8.

    Aykan HH, Karagöz T, Akın A, İrdem A, Özer S, Çeliker A (2014) Results of radiofrequency ablation in children with tachycardia-induced cardiomyopathy. Anadolu Kardiyol Derg 14:625–630

  9. 9.

    Carson P, Anand I, Jaski B, Steinberg J, Lwin A, Bristow MR et al (2005) Mode of death in advanced heart failure: the Comparison of Medical, Pacing, and Defibrillation Therapies in Heart Failure (COMPANION) trial. J Am Coll Cardiol 46:2329–2334

  10. 10.

    Romeo F, Pellicia F, Cianfrocca C, Cristofani R, Reale A (1989) Predictors of sudden death in idiopathic dilated cardiomyopathy. Am J Cardiol 63:138

  11. 11.

    Akdeniz B, Guneri S, Savas IZ, Aslan O, Baris N, Badak O, Kirimli O, Göldeli O (2006) Effects of carvedilol therapy on arrhythmia markers in patients with congestive heart failure. Int Heart J 47:565–573

  12. 12.

    Gehi A, Haas D, Fuster V (2005) Primary prophylaxis with the implantable cardioverter-defibrillator: the need for improved risk stratification. JAMA 294:958–960

  13. 13.

    Allen HD, Shaddy RE, Penny DJ, Cetta F, Feltes TF (2016) Moss and Adam’s heart disease in infants, children and adolescents: including the fetus and young adult. In: Lin KY, Rossano JW (eds) Dilated cardiomyopathy, 9th edn. Volters Kluver, pp 1283–1295

  14. 14.

    Dec GW, Fuster V (1994) Idiopathic dilated cardiomyopathy. N Engl J Med 331:1564–1575

  15. 15.

    Meinertz T, Hofmann T, Kasper W et al (1984) Significance of ventricular arrhythmias in idiopathic dialed cardiomyopathy. Am J Cardiol 53:902

  16. 16.

    Duy DT, Hollander SA, Rosenthal DN, Dubin AM (2013) QRS prolongation is strongly associated with life-threatening ventricular arrhythmias in children with dilated cardiomyopathy. J Heart Lung Transplant 32:1013–1019

  17. 17.

    Hegazy AR, Lotfy NW (2007) The value of Holter monitoring in the assessment of pediatric patients. Indian Pacing Electrophysiol J 7:204–214

  18. 18.

    Dimas VV, Denfield SW, Friedman RA, Cannon BC, Kim JJ, Smith EO, Clunie SK, Price JF, Towbin JA, Dreyer WJ, Kertesz NJ (2009) Frequency of cardiac death in children with idiopathic dilated cardiomyopathy. Am J Cardiol 104:1574–1577

  19. 19.

    Rhee EK, Canter CE, Basile S, Webber SA, Naftel DC (2007) Sudden death prior to pediatric heart transplantation: would implantable defibrillators improve outcome? J Heart Lung Transplant 26:447–452

  20. 20.

    Kulan K, Komsuoglu B, Tuncer C, Kulan C (1996) Significance of QT dispersion on ventricular arrhythmias in mitral valve prolapse. Int J Cardiol 54:251–257

  21. 21.

    Yontar OC, Karaagac K, Tenekecioglu E, Tutuncu A, Demir M, Melek M (2014) Assessment of ventricular repolarization inhomogeneity in patients with mitral valve prolapse: value of T wave peak to end interval. Int J Clin Exp Med 7(8):2173–2178

  22. 22.

    Porthan K, Viitasalo M, Toivonen L, Havulinna AS, Jula A, Tikkanen JT, Väänänen H, Nieminen MS, Huikuri HV, Newton-Cheh C, Salomaa V, Oikarinen L (2013) Predictive value of electrocardiographic T-wave morphology parameters and T-wave peak to T-wave end interval for sudden cardiac death in the general population. Circ Arrhythm Electrophysiol 6:690–696

  23. 23.

    Laurita KR, Girouard SD, Akar FG, Rosenbaum DS (1998) Modulated dispersion explains changes in arrhythmia vulnerability during premature stimulation of the heart. Circulation. 98:2774–2780

  24. 24.

    Antzelevitch C (2007) Role of spatial dispersion of repolarization in inherited and acquired sudden cardiac death syndromes. Am J Physiol Heart Circ Physiol 293:2024–2038

  25. 25.

    Kors JA, Ritsema van Eck HJ, van Herpen G (2008) The meaning of the Tp–Te interval and its diagnostic value. J Electrocardiol 41:575–580

  26. 26.

    Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT, Yan GX (2008) T(p–e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol 41:567–574

  27. 27.

    Bachmann TN, Skov MW, Rasmussen PV, Graff C, Pietersen A, Lind B, Struijk JJ, Olesen MS, Haunsø S, Køber L, Svendsen JH, Holst AG, Nielsen JB (2016) Electrocardiographic Tpeak-tend interval and risk of cardiovascular morbidity and mortality: results from the Copenhagen ECG study. Heart Rhythm 13:915–924

  28. 28.

    Rosenthal TM, Stahls PF, Abi Samra FM, Bernard ML, Khatib S, Polin GM et al (2015) T-peak to T-end interval for prediction of ventricular tachyarrhythmia and mortality in a primary prevention population with systolic cardiomyopathy. Heart Rhythm 12:1789–1797

  29. 29.

    Morin DP, Saad MN, Shams OF, Owen JS, Xue JQ, Abi-Samra FM, et al. Relationships between the T-peak to T-end interval, ventricular tachyarrhythmia, and death in left ventricular systolic dysfunction. Europace. 2012; 14:1172–1179

  30. 30.

    Yamaguchi M, Shimizu M, Ino H, Terai H, Uchiyama K, Oe K et al (2003) T wave peak-to-end interval and QT dispersion in acquired long QT syndrome: a new index for arrhythmogenicity. Clin Sci (Lond) 105:671–676

  31. 31.

    Atıcı A, Panç C, Karaayvaz EB, Demirkıran A, Kutlu O, Kaşalı K, Kekeç E, Sarı L, Akyol Sarı ZN, Bilge AK (2018) Evaluation of the Tp-Te interval, Tp-Te/QTc ratio, and QT dispersion in patients with Turner syndrome. Anatol J Cardiol 20:93–99

  32. 32.

    Panikkath R, Reinier K, Uy-Evanado A, Teodorescu C, Hattenhauer J, Mariani R, Gunson K, Jui J, Chugh SS (2011) Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol 4:441–447

  33. 33.

    Shimizu M, Ino H, Okeie K, Yamaguchi M, Nagata M, Hayashi K et al T-peak to T-end interval may be a better predictor of high-risk patients with hypertrophic cardiomyopathy associated with a cardiac troponin I mutation than QT dispersion. Clin Cardiol 25(7):335–339

  34. 34.

    Yap YG, Camm AJ (2003) Drug induced QT prolongation and torsades de pointes. Heart 89:1363–1372

  35. 35.

    Schwartz PJ (2001) QT prolongation, sudden death, and sympathetic imbalance: the pendulum swings. J Cardiovasc Electrophysiol 12:1074–1077

  36. 36.

    Davey P (2000) QT interval and mortality from coronary artery disease. Prog Cardiovasc Dis 42:359–384

  37. 37.

    Al-Khatib SM, LaPointe NM, Kramer JM, Califf RM (2003) What clinicians should know about the QT interval. JAMA 289:2120–2127

  38. 38.

    Robbins J, Nelson JC, Rautaharju PM, Gottdiener JS (2003) The association between the length of the QT interval and mortality in the cardiovascular health study. Am J Med 115:689–694

  39. 39.

    Luna AB, Vinolas X (1997) Clinical utilities of QT interval dynamicity. In: Malik M (ed) Cardiac Electrophysiology Review. Kluwer Academic Publisher, pp 368–371

  40. 40.

    Myerburg RJ, Castellanos A (1992) Cardiac arrest and sudden cardiac death. In: Braunwald E (ed) Heart disease: a textbook of cardiovascular Medicine, 4th edn. WB Saunders, Philadelphia, pp 756–789

  41. 41.

    Yetman AT, Hamilton RM, Benson LE, McCrindle BW (1998) Long-term outcome and prognostic determinants in children with hypertrophic cardiomyopathy. J Am Coll Cardiol 32:1943–1950

  42. 42.

    Shi B, Harding SA, Jimenez A, Larsen PD (2013) Standard 12-lead electrocardiography measures predictive of increased appropriate therapy in implantable cardioverter defibrillator recipients. Europace 15:892–898

  43. 43.

    Ozdemir R, Isguder R, Kucuk M, Karadeniz C, Ceylan G, Katipoglu N et al (2016) J Trop Pediatr 62:377–384

  44. 44.

    Amoozgar H, Ahmadipour M, Amirhakimi A (2013) nt Cardiovasc Res J 7(3):99–103

  45. 45.

    Ankit M, Norby FL, Soliman EZ, Alraies MC, Adabag S et al (2017) Relation of prolonged P-wave duration to risk of sudden cardiac death in the general population (from the Atherosclerosis Risk in Communities Study). Am J Cardiol 119(9):1302–1306

  46. 46.

    Narayanan K, Chugh SS (2015) The 12-lead electrocardiogram and risk of sudden death: current utility and future prospects. Europace.

  47. 47.

    Chen LY, Sotoodehnia N, BůŹková P, Lopez FL, Yee LM, Heckbert SR et al (2013) Atrial fibrillation and the risk of sudden cardiac death: the atherosclerosis risk in communities study and cardiovascular health study. JAMA Intern Med 173:29–35

  48. 48.

    Tereshchenko LG, Henrikson CA, Sotoodehnia N, Arking D, Agarwal S, Siscovick D et al (2014) Electrocardiographic deep terminal negativity of the P wave in V(1) and risk of sudden cardiac death: the Atherosclerosis Risk in Communities (ARIC) study. J Am Hear Assoc 3

  49. 49.

    Necati DAGLI, Ilgın KARACA (2006) Fırat Tıp Dergisi 11(3):154–159

  50. 50.

    Goldberger JJ, Kadish AH (1999) Cardiac memory. PACE 22:1672–1679

  51. 51.

    Narayan SM (2006) T-wave alternans and the susceptibility to ventricular arrhythmias. J Am Coll Cardiol 47:269–281

  52. 52.

    Ashwath ML, Okosun I, Sogade FO (2005) QRS width and its impact on inducibility of ventricular arrhythmia at the time of electrophysiology study. J Natl Med Assoc 97:695–698

  53. 53.

    Sakhuja R, Chen AA, Anwaruddin S, Baggish AL, Januzzi JL (2005) Combined use of amino terminal-pro-brain natriuretic peptide levels and QRS duration to predict left ventricular systolic dysfunction in patients with dyspnea. Am J Cardiol 96:263–266

  54. 54.

    Murkofsky RL, Dangas G, Diamond JA, Mehta D, Schaffer A, Ambrose JA (1998) A prolonged QRS duration on surface electrocardiogram is a specific indicator of left ventricular dysfunction. J Am Coll Cardiol 32:476–482

  55. 55.

    Goldberger Z, Lampert R (2006) Implantable cardioverter-defibrillators: expanding indications and technologies. JAMA 295:809–818

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Author information

All authors fulfill the criteria for authorship; M.T. and A.A. initiated the study; M.T., M.B., and H.B. collected the data; M.T., A.A., and M.B. analyzed the data; A.A., M.T., and A.N. interpreted the data; A.N. and M.T. drafted the report. All authors commented on the drafts and have seen and approved the final version.

Correspondence to Mehmet Türe.

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The authors declare that they have no conflict of interest.

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Our study received ethics approval from the Dicle University Medical Faculty non-interventional clinical studies ethics committee.

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Informed consent was obtained from all individual participants included in the study.

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Cite this article

Türe, M., Balık, H., Akın, A. et al. The relationship between electrocardiographic data and mortality in children diagnosed with dilated cardiomyopathy. Eur J Pediatr (2020) doi:10.1007/s00431-020-03569-9

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Keywords

  • Dilated cardiomyopathy
  • Electrocardiography
  • Mortality
  • Children