Prognostic value of cardiopulmonary exercise testing in children with heart failure secondary to idiopathic dilated cardiomyopathy in a non-β-blocker therapy setting

Background: Peak oxygen consumption and resting left ventricular ejection fraction (LVEF) are independent predictors of survival in adult heart failure (HF) patients. Aim: To evaluate these factors in children. Methods: We prospectively studied 31 children with NYHA class I to III HF (mean LVEF 26 +/- 10%; mean age 8.6 +/- 1.9 years). All had dilated cardiomyopathy and were awaiting heart transplantation. A cardiopulmonary treadmill exercise test was performed and LVEF determined by radionuclide venfticulography. Results: During a median follow-up of 1282 days, 20 children reached at least one end-point (death or heart transplantation). Clinical data from the 11children without events and the 20 children with events are as follows: NYHA class 1 +/- 0 vs. 2 +/- 0.9 (p < 0.01); SBP 118 +/- 17 vs. 102 +/- 16 (p=0.01); DBP 70 +/- 10 vs. 61 +/- 10 (p=0.02); heart rate 165 +/- 22 vs. 148 +/- 22 (NS); double-product 19 +/- 4 vs. 15 +/- 4 (P=0.01); endtidal carbon dioxide tension (PetCO,) 35 5 vs. 30 6 (NS); oxygen consumption (VO2) 22 +/- 5.4 vs. 18.3 +/- 5.7 (NS); exercise time 19 +/- 4 vs. 13 +/- 6 (p < 0.003), and LVEF 31 +/- 8 vs. 22 +/- 10 (p=0.02). These variables all correlated with prognosis on univariate analysis. In multivariate analysis, only decreasing exercise time and LVEF were predictive of events during follow-up (p < 0.001 and 0.04). Conclusion: These findings suggest that reduction in LVEF and exercise tolerance in children with heart failure is predictive of functional status. (c) 2008 European Society of Cardiology. Published by Elsevier B.V All rights reserved.