Chen S et al. – This study evaluated associations between hemodynamic profiles and symptoms, end-organ function and outcome in children with end-stage heart failure listed for heart transplantation. Congestion was found to be more common than low cardiac output and correlated with end-stage dysfunction and New York Heart Association (NYHA)/Ross classification. Clinical deterioration or highest risk of death was noted in children having both congestion and low output.

Methods

• Children aged <18 years (N = 1059, median age 6.9 years) were included for heart transplant.
• Cardiac catheterization data were collected for pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), and cardiac index (CI).

Results

• The data revealed that 46% had dilated cardiomyopathy, 58% had congestion (PCWP >15 mm Hg), 28% had severe congestion (PCWP >22mm Hg), and 22% had low cardiac output (CI <2.2 L/min/m2)Children meeting primary outcome of death (9%) or clinical deterioration (12%) were 21%.
• Worse NYHA/Ross classification was associated with significantly increased risk of PCWP (P = .01), renal dysfunction with increased risk of RAP (P = .007), and hepatic dysfunction with both increased PCWP (P<.001) and increased RAP (P<.001). However, no associations were found with low output.
• Death or clinical deterioration was associated with severe congestion (odds ratio [OR] 1.2-2.2, P = .002), but not with CI alone.
• Children were at highest risk of death (OR 1.9, P = .03) if they had both low output and severe congestion.