[Age-stratified analysis of left ventricular ejection fraction threshold heterogeneity for heart failure with preserved ejection fraction in children].

摘要

Objective: To explore age-adapted left ventricular ejection fraction (LVEF) diagnostic thresholds for heart failure with preserved ejection fraction (HFpEF) in children. Methods: In this multicenter retrospective cohort study, children with chronic heart failure were selected from 3 546 hospitalized pediatric heart failure patients across 30 medical centers in 20 provinces, autonomous regions and municipalities in China from January 2013 to December 2022. Children were divided into 3 groups based on LVEF:<50%, 50%-<55%, and ≥55%. Age-stratified analyses were performed using cutoffs at 9, 10, 11, 12, and 13 years of age. Intergroup comparisons were conducted using the chi-square test or Fisher's exact test, Wilcoxon rank-sum test or Kruskal-Wallis test. Multivariable linear regression was used to analyze the independent association between LVEF categories and cardiac structural parameters. Results: A total of 1 018 pediatric patients were included in the analysis. Among them, 527 (51.8%) were male and 491 (48.2%) were female, with an age of 1.2 (0.4, 7.1) years. There were 447 children in LVEF <50% group, 62 children in 50%-<55% group, and 509 children in ≥55% group. Statistical differences in baseline clinical characteristics were observed among the 3 groups, including age, heart rate, respiratory symptoms, systemic congestion symptoms, congenital heart disease, cardiomyopathy cardiovascular events, growth retardation (all P<0.05). Age-stratified analysis showed that when using 9, 10 and 11 years of age as cutoffs, left ventricular end-systolic diameter (LVESD) differed between the LVEF <50% and 50%-<55% groups in children aged at or above the respective cutoff (all P<0.05). When using 12 and 13 years of age as the cutoff, left atrial diameter differed between the LVEF 50%-<55% and ≥55% groups in children below 12 and 13 years of age (both P<0.05). After adjustment for covariates using multivariable linear regression, when using 10 and 11 years of age as the cut-offs, LVEF were correlated with LVESD in both children aged ≥10 years and those aged ≥11 years (β=11.62 and 10.94,95%CI 2.38-20.85 and 1.32-20.56, P=0.018 and 0.029). And when using 12 years of age as the cut-offs, LVEF was correlated with left atrial diameter in children aged <12 years of age (β=-1.82,95%CI -3.29--0.35,P=0.015). Conclusion: Age-related heterogeneity may exist in the LVEF thresholds for pediatric HFpEF, an LVEF threshold of 55% is recommended for children younger than 12 years, whereas 50% consistent with adult criteria, may be considered for those aged 12 years or older. 目的： 探索儿童射血分数保留的心力衰竭（HFpEF）的年龄适应性左心室射血分数（LVEF）诊断界值。 方法： 多中心回顾性队列研究。从2013年1月至2022年12月中国20个省、自治区、直辖市30个医疗中心的3 546例心力衰竭患儿中筛选出慢性心力衰竭患儿。根据LVEF水平分为<50%、50%~<55%和≥55% 3组，以9、10、11、12、13岁为节点进行年龄分层。组间比较采用χ²检验或Fisher确切概率法，Kruskal-Wallis H检验或Wilcoxon秩和检验。采用多因素线性回归模型分析不同LVEF分组与心脏结构指标的独立关联。 结果： 纳入分析的1 018例慢性心力衰竭患儿中男527例（51.8%），女491例（48.2%），年龄1.2（0.4，7.1）岁。LVEF<50%组447例，50%~<55%组62例，≥55%组509例。3组患儿基线临床特征包括年龄，心率，有呼吸道症状、体循环淤血症状、先天性心脏病、心肌病、心血管事件、生长发育迟缓比例差异均有统计学意义（均P<0.05）。年龄分层分析显示，以9、10和11岁为节点，≥年龄节点的患儿中LVEF<50%组与50%~<55%组左心室收缩末期内径（LVESD）差异均有统计学意义（均P<0.05）；以12、13岁为节点，<年龄节点的患儿中LVEF 50%~<55%组与≥55%组左心房内径差异均有统计学意义（均P<0.05）。多因素线性回归调整协变量后，以10、11岁为节点，≥10岁和≥11岁患儿中LVEF与LVESD均有关联（β=11.62、10.94，95%CI 2.38~20.85、1.32~20.56，P=0.018、0.029）；以12岁为节点，<12岁患儿中LVEF与左心房内径有关联（β=-1.82，95%CI -3.29~-0.35，P=0.015）。 结论： 儿童HFpEF的LVEF诊断界值可能具有年龄异质性，<12岁建议采用LVEF 55%作为界值，≥12岁患儿可考虑采用与成人一致的LVEF 50%作为界值。.