Children with both congestion and low cardiac output display the highest risk of mortality or clinical deterioration


eMediNexus    15 December 2017

A study that determined the link between hemodynamic profiles and symptoms, end-organ function and outcome in children listed for heart transplantation showed that congestion is comparatively more common than low cardiac output in children with end-stage heart failure and correlates with New York Heart Association (NYHA)/Ross classification and end-organ dysfunction. Thus, children with both congestion and low output have the highest risk of death or clinical deterioration. The results published in the European Heart Journal demonstrated that out of 1,059 children analysed, 58% had congestion, 28% had severe congestion, and 22% low cardiac output. Moreover, 21% children met the primary outcome of death (9%) or clinical deterioration (12%). In multivariable analysis, worse NYHA/Ross classification was associated with increased pulmonary capillary wedge pressure (PCWP), renal dysfunction with increased RAP, and hepatic dysfunction with both increased PCWP and increased right atrial pressure (RAP). No relation was shown with low output. Death or clinical deterioration was related to severe congestion, but not with cardiac index (CI) alone.

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