Heart Failure with Preserved Ejection Fraction in Children

Overview

Journal Pediatr Cardiol

Specialties Cardiology & Vascular Diseases
Pediatrics

Date 2022 Aug 17

PMID 35978175

Authors

Bibhuti Das

Shriprasad Deshpande

Jyothsna Akam-Venkata

Divya Shakti

William Moskowitz

Steven E Lipshultz

Affiliations

Soon will be listed here.

Abstract

Diastolic dysfunction (DD) refers to abnormalities in the mechanical function of the left ventricle (LV) during diastole. Severe LVDD can cause symptoms and the signs of heart failure (HF) in the setting of normal or near normal LV systolic function and is referred to as diastolic HF or HF with preserved ejection fraction (HFpEF). Pediatric cardiologists have long speculated HFpEF in children with congenital heart disease and cardiomyopathy. However, understanding the risk factors, clinical course, and validated biomarkers predictive of the outcome of HFpEF in children is challenging due to heterogeneous etiologies and overlapping pathophysiological mechanisms. The natural history of HFpEF varies depending upon the patient's age, sex, race, geographic location, nutritional status, biochemical risk factors, underlying heart disease, and genetic-environmental interaction, among other factors. Pediatric onset HFpEF is often not the same disease as in adults. Advances in the noninvasive evaluation of the LV diastolic function by strain, and strain rate analysis with speckle-tracking echocardiography, tissue Doppler imaging, and cardiac magnetic resonance imaging have increased our understanding of the HFpEF in children. This review addresses HFpEF in children and identifies knowledge gaps in the underlying etiologies, pathogenesis, diagnosis, and management, especially compared to adults with HFpEF.

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References

Hsu D, Pearson G . Heart failure in children: part I: history, etiology, and pathophysiology. Circ Heart Fail. 2009; 2(1):63-70. DOI: 10.1161/CIRCHEARTFAILURE.108.820217. View

Dragulescu A, Mertens L, Friedberg M . Interpretation of left ventricular diastolic dysfunction in children with cardiomyopathy by echocardiography: problems and limitations. Circ Cardiovasc Imaging. 2013; 6(2):254-61. DOI: 10.1161/CIRCIMAGING.112.000175. View

Chowdhury S, Butts R, Hlavacek A, Taylor C, Chessa K, Bandisode V . Echocardiographic Detection of Increased Ventricular Diastolic Stiffness in Pediatric Heart Transplant Recipients: A Pilot Study. J Am Soc Echocardiogr. 2017; 31(3):342-348.e1. PMC: 5837912. DOI: 10.1016/j.echo.2017.11.010. View

Masutani S, Saiki H, Kurishima C, Ishido H, Tamura M, Senzaki H . Heart failure with preserved ejection fraction in children: hormonal imbalance between aldosterone and brain natriuretic peptide. Circ J. 2013; 77(9):2375-82. DOI: 10.1253/circj.cj-12-1271. View

Steiner R . Increasing exercise in long-term survivors of pediatric cancer and their siblings: should treatment be a family affair?. Pediatr Blood Cancer. 2013; 60(4):529-30. DOI: 10.1002/pbc.24465. View

Lipshultz S, Colan S, Gelber R, Perez-Atayde A, Sallan S, Sanders S . Late cardiac effects of doxorubicin therapy for acute lymphoblastic leukemia in childhood. N Engl J Med. 1991; 324(12):808-15. DOI: 10.1056/NEJM199103213241205. View

Lipshultz S, Lipsitz S, Sallan S, Dalton V, Mone S, Gelber R . Chronic progressive cardiac dysfunction years after doxorubicin therapy for childhood acute lymphoblastic leukemia. J Clin Oncol. 2005; 23(12):2629-36. DOI: 10.1200/JCO.2005.12.121. View

Chang H, Lee C, Su P, Li S, Chen M, Chen Y . Subtle cardiac dysfunction in lymphoma patients receiving low to moderate dose chemotherapy. Sci Rep. 2021; 11(1):7100. PMC: 8007606. DOI: 10.1038/s41598-021-86652-x. View

Adams M, Lipsitz S, Colan S, Tarbell N, Treves S, Diller L . Cardiovascular status in long-term survivors of Hodgkin's disease treated with chest radiotherapy. J Clin Oncol. 2004; 22(15):3139-48. DOI: 10.1200/JCO.2004.09.109. View

10.

Echeverria H, Bilsker M, Myerburg R, Kessler K . Congestive heart failure: echocardiographic insights. Am J Med. 1983; 75(5):750-5. DOI: 10.1016/0002-9343(83)90403-5. View

11.

Dougherty A, Naccarelli G, Gray E, Hicks C, Goldstein R . Congestive heart failure with normal systolic function. Am J Cardiol. 1984; 54(7):778-82. DOI: 10.1016/s0002-9149(84)80207-6. View

12.

Adams Jr K, Fonarow G, Emerman C, Lejemtel T, Costanzo M, Abraham W . Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005; 149(2):209-16. DOI: 10.1016/j.ahj.2004.08.005. View

13.

Virani S, Alonso A, Aparicio H, Benjamin E, Bittencourt M, Callaway C . Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021; 143(8):e254-e743. DOI: 10.1161/CIR.0000000000000950. View

14.

Ziaeian B, Fonarow G . Epidemiology and aetiology of heart failure. Nat Rev Cardiol. 2016; 13(6):368-78. PMC: 4868779. DOI: 10.1038/nrcardio.2016.25. View

15.

Kane G, Karon B, Mahoney D, Redfield M, Roger V, Burnett Jr J . Progression of left ventricular diastolic dysfunction and risk of heart failure. JAMA. 2011; 306(8):856-63. PMC: 3269764. DOI: 10.1001/jama.2011.1201. View

16.

Redfield M, Jacobsen S, Burnett Jr J, Mahoney D, Bailey K, Rodeheffer R . Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA. 2003; 289(2):194-202. DOI: 10.1001/jama.289.2.194. View

17.

J Lasa J, Gaies M, Bush L, Zhang W, Banerjee M, Alten J . Epidemiology and Outcomes of Acute Decompensated Heart Failure in Children. Circ Heart Fail. 2020; 13(4):e006101. PMC: 7169981. DOI: 10.1161/CIRCHEARTFAILURE.119.006101. View

18.

Miyake T . Doppler echocardiographic studies of diastolic cardiac function in the human fetal heart. Kurume Med J. 2001; 48(1):59-64. DOI: 10.2739/kurumemedj.48.59. View

19.

Schmitz L, Xanthopoulos A, Koch H, Lange P . Doppler flow parameters of left ventricular filling in infants: how long does it take for the maturation of the diastolic function in a normal left ventricle to occur?. Pediatr Cardiol. 2004; 25(5):482-91. DOI: 10.1007/s00246-003-0605-1. View

20.

Mori K, Nakagawa R, Nii M, Edagawa T, Takehara Y, Inoue M . Pulsed wave Doppler tissue echocardiography assessment of the long axis function of the right and left ventricles during the early neonatal period. Heart. 2004; 90(2):175-80. PMC: 1768064. DOI: 10.1136/hrt.2002.008110. View