Evaluation of children's diagnose dilated cardiomyopathy

Introduction and Objective: Dilated cardiomyopathy (DCMP) is a common heart condition during childhood with high mortality rates. In many patients, the etiology is unknown. Myocarditis is the most common cause of DCMP in patients with a known etiology. A significant portion of patients are diagnosed before they reach one year of age. This study aims to investigate etiological causes of DCMP and mortality in pediatric cases. Materials and Methods: Data of a total of 37 patients diagnosed with DCMP, who were admitted to and followed at Dicle University, Faculty of Medicine, Department of Pediatric Cardiology between January 2012 and October 2016 were retrospectively analyzed. Data including age and sex of the patients, complaints on admission, status of kinship, family history, physical examination findings, laboratory results, echocardiography and electrocardiography findings at the time of diagnosis, cardiac catheterization or angiography results, etiology and the up-to-date clinical status of the patients at scheduled follow-up visits were recorded. The etiology of DCMP was classified into two groups: idiopathic DCMP and DCMP related to other factors. Up-to-date status of the patients was classified into two groups: survivors and non-survivors. The relationship between these groups and other parameters was analyzed. Results: The mean age was 27 ± 50 (range: 0.5 to 204) months. A total of 67.6% of the patients were 0 to 12 months old, 18.9% of the patients were 13 months to 5 years old, and 13.5% of the patients were above 5 years old. A total of 56.7% were males, whereas 43.3% were females. Of the patients, 16.2% died within 8 (range: 2 to 33) months after the diagnosis, while 83.8% were still alive with a mean follow-up of 27 (range: 1 to 59) months. Sixty percent of the patients achieved normal left ventricle ejection fraction levels. Etiology of DCMP remained unknown in 56.8% of the patients, while 24.3% of the patients with a known etiology were diagnosed with infectious causes-related DCMP, 8.1% with chronic kidney disease, 2.7% with metabolic disease, 2.7% with chemotherapy (doxorubicin), 2.7% with aortic coarctation, and 2.7% with DCMP secondary to anomalous left coronary artery from pulmonary artery. Four patients (10%) died within nearly one year after the diagnosis. A total of 83,3% of the non-survivors and 29% of the survivors had tachycardia, indicating a statistically significantly higher incidence of tachycardia in non-survivors (p=0.023). Electrocardiography results of 80% of the non-survivors and 17.8% of the survivors suggested ischemia, indicating a statistically significant difference between the groups (p=0.012). Hemoglobin level was slightly higher and sodium level was lower in idiopathic DCMP group (p<0.05). Conclusion: Our study results showed that a significant portion of the patients were diagnosed before they reached one year of age. Idiopathic etiology was the most common cause of DCMP, while infectious causes were the most common cause of the disease among the patients with a known etiology. Based on these findings, as the majority of the mortality occurs within the first year, a close clinical follow-up is required. In addition, tachycardia and ischemic changes on electrocardiography are more frequent in non-survivors, suggesting that these two symptoms may be the predictors of mortality. Keywords: Dilated cardiomyopathy, child, myocarditis.