A Clinical Risk Score to Improve the Diagnosis of Tachycardia-Induced Cardiomyopathy in Childhood

Jeremy P. Moore, Shuo Wang, Erin L. Albers, Jack C. Salerno, Elizabeth A. Stephenson, Maully J. Shah, Andreas Pflaumer, Richard J. Czosek, Jason M. Garnreiter, Kathryn Collins, Andrew L. Papez, Shubhayan Sanatani, Nicole B. Cain, Prince J. Kannankeril, James C. Perry, Ravi Mandapati, Jennifer N A Silva, Seshadri Balaji, Kevin M. Shannon

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Tachycardia-induced cardiomyopathy (TIC) is a treatable cause of heart failure in children, but there is little information as to which clinical variables best discriminate TIC from other forms of cardiomyopathy. TIC cases with dilated cardiomyopathy (DC) from 16 participating centers were identified and compared with controls with other forms of DC. Presenting clinical, echocardiographic, and electrocardiographic characteristics were collected. Heart rate (HR) percentile was defined as HR/median HR for age, and PR index as the PR/RR interval. P-wave morphology (PWM) was defined as possible sinus or nonsinus based on a predefined algorithm. Eighty TIC cases and 135 controls were identified. Cases demonstrated lower LV end-diastolic diameter and LV end-systolic diameter than DC controls (4.3 vs 6.5, p <0.001; 7.4 vs 10.9, p <0.001) and were less likely to receive inotropic medication at presentation (p <0.001 for both). Multivariable logistic regression identified HR percentile (OR 2.1 per 10% increase, CI 1.3 to 4.6; p = 0.014), PR index (OR 1.2, CI 1.1 to 1.4; p = 0.004), and nonsinus PWM (OR 104.9, CI 15.2 to 1,659.8; p <0.001) as predictive of TIC status. A risk score using HR percentile >130%, PR index >30%, and nonsinus PWM was associated with a sensitivity of 100% and specificity of 87% for the diagnosis of TIC. Model training and validation area under the curves were similar at 0.97 and 0.94, respectively. In conclusion, pediatric TIC may be accurately discriminated from other forms of DC using simple electrocardiographic parameters. This may allow for rapid diagnosis and early treatment of this condition.

Original languageEnglish (US)
Pages (from-to)1074-1080
Number of pages7
JournalAmerican Journal of Cardiology
Volume118
Issue number7
DOIs
StatePublished - Oct 1 2016

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Cardiomyopathies
Tachycardia
Dilated Cardiomyopathy
Heart Rate
Area Under Curve
Heart Failure
Pediatrics
Sensitivity and Specificity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Moore, J. P., Wang, S., Albers, E. L., Salerno, J. C., Stephenson, E. A., Shah, M. J., ... Shannon, K. M. (2016). A Clinical Risk Score to Improve the Diagnosis of Tachycardia-Induced Cardiomyopathy in Childhood. American Journal of Cardiology, 118(7), 1074-1080. https://doi.org/10.1016/j.amjcard.2016.07.008

A Clinical Risk Score to Improve the Diagnosis of Tachycardia-Induced Cardiomyopathy in Childhood. / Moore, Jeremy P.; Wang, Shuo; Albers, Erin L.; Salerno, Jack C.; Stephenson, Elizabeth A.; Shah, Maully J.; Pflaumer, Andreas; Czosek, Richard J.; Garnreiter, Jason M.; Collins, Kathryn; Papez, Andrew L.; Sanatani, Shubhayan; Cain, Nicole B.; Kannankeril, Prince J.; Perry, James C.; Mandapati, Ravi; Silva, Jennifer N A; Balaji, Seshadri; Shannon, Kevin M.

In: American Journal of Cardiology, Vol. 118, No. 7, 01.10.2016, p. 1074-1080.

Research output: Contribution to journalArticle

Moore, JP, Wang, S, Albers, EL, Salerno, JC, Stephenson, EA, Shah, MJ, Pflaumer, A, Czosek, RJ, Garnreiter, JM, Collins, K, Papez, AL, Sanatani, S, Cain, NB, Kannankeril, PJ, Perry, JC, Mandapati, R, Silva, JNA, Balaji, S & Shannon, KM 2016, 'A Clinical Risk Score to Improve the Diagnosis of Tachycardia-Induced Cardiomyopathy in Childhood', American Journal of Cardiology, vol. 118, no. 7, pp. 1074-1080. https://doi.org/10.1016/j.amjcard.2016.07.008
Moore, Jeremy P. ; Wang, Shuo ; Albers, Erin L. ; Salerno, Jack C. ; Stephenson, Elizabeth A. ; Shah, Maully J. ; Pflaumer, Andreas ; Czosek, Richard J. ; Garnreiter, Jason M. ; Collins, Kathryn ; Papez, Andrew L. ; Sanatani, Shubhayan ; Cain, Nicole B. ; Kannankeril, Prince J. ; Perry, James C. ; Mandapati, Ravi ; Silva, Jennifer N A ; Balaji, Seshadri ; Shannon, Kevin M. / A Clinical Risk Score to Improve the Diagnosis of Tachycardia-Induced Cardiomyopathy in Childhood. In: American Journal of Cardiology. 2016 ; Vol. 118, No. 7. pp. 1074-1080.
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abstract = "Tachycardia-induced cardiomyopathy (TIC) is a treatable cause of heart failure in children, but there is little information as to which clinical variables best discriminate TIC from other forms of cardiomyopathy. TIC cases with dilated cardiomyopathy (DC) from 16 participating centers were identified and compared with controls with other forms of DC. Presenting clinical, echocardiographic, and electrocardiographic characteristics were collected. Heart rate (HR) percentile was defined as HR/median HR for age, and PR index as the PR/RR interval. P-wave morphology (PWM) was defined as possible sinus or nonsinus based on a predefined algorithm. Eighty TIC cases and 135 controls were identified. Cases demonstrated lower LV end-diastolic diameter and LV end-systolic diameter than DC controls (4.3 vs 6.5, p <0.001; 7.4 vs 10.9, p <0.001) and were less likely to receive inotropic medication at presentation (p <0.001 for both). Multivariable logistic regression identified HR percentile (OR 2.1 per 10{\%} increase, CI 1.3 to 4.6; p = 0.014), PR index (OR 1.2, CI 1.1 to 1.4; p = 0.004), and nonsinus PWM (OR 104.9, CI 15.2 to 1,659.8; p <0.001) as predictive of TIC status. A risk score using HR percentile >130{\%}, PR index >30{\%}, and nonsinus PWM was associated with a sensitivity of 100{\%} and specificity of 87{\%} for the diagnosis of TIC. Model training and validation area under the curves were similar at 0.97 and 0.94, respectively. In conclusion, pediatric TIC may be accurately discriminated from other forms of DC using simple electrocardiographic parameters. This may allow for rapid diagnosis and early treatment of this condition.",
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AU - Stephenson, Elizabeth A.

AU - Shah, Maully J.

AU - Pflaumer, Andreas

AU - Czosek, Richard J.

AU - Garnreiter, Jason M.

AU - Collins, Kathryn

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AU - Perry, James C.

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