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Echocardiographic predictors of adverse clinical events in children with dilated cardiomyopathy: a prospective clinical study
  1. C J McMahon1,
  2. S F Nagueh2,
  3. R S Eapen3,
  4. W J Dreyer1,
  5. I Finkelshtyn1,
  6. X Cao1,
  7. B W Eidem1,
  8. L I Bezold1,
  9. S W Denfield1,
  10. J A Towbin1,
  11. R H Pignatelli1
  1. 1Lillie Frank Abercrombie Department of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas, USA
  2. 2Department of Cardiology, Methodist Hospital, Baylor College of Medicine, Houston, Texas, USA
  3. 3Department of Pediatric Cardiology, University at Southwestern Medical School, Dallas, Texas, USA
  1. Correspondence to:
    Dr C J McMahon
    Lillie Frank Abercrombie Division of Pediatric Cardiology, Texas Children’s Hospital, 6621 Fannin, Houston, Texas 77030, USA;


Objectives: To compare tissue Doppler (TD) velocities between patients with dilated cardiomyopathy (DCM) and normal controls and to determine whether TD velocities, Tei index, right ventricular fractional area change, and left ventricular ejection fraction (LVEF) predict adverse clinical outcomes in children with DCM.

Methods: Prospective evaluation of children with DCM.

Results: 54 children with DCM and 54 age and sex matched control group participants were studied. Mitral inflow velocities were similar for both groups except for decreased mitral deceleration time in patients with DCM. Systolic and diastolic TD velocities at the mitral annulus (septal and lateral sides) and tricuspid annulus were significantly reduced in children with DCM compared with controls (p < 0.001 for each). By multivariate analysis, after adjustment for Tei index and right ventricular fractional area change, decreased LVEF and tricuspid velocity during early diastole (Ea) were predictors of the primary end point (PEP), a composite end point consisting of need for hospitalisation or the outcome transplantation or death. Tricuspid Ea velocity < 8.5 cm/s had 87% specificity and 60% sensitivity for reaching the PEP. LVEF < 30% had 68% specificity and 74% sensitivity for the PEP. Combined LVEF < 30% and tricuspid Ea < 11.5 cm/s had 100% specificity and 44% sensitivity for the PEP.

Conclusions: Children with DCM have significantly lower TD velocities than normal controls. In such cases, lower LVEF (< 30%) is more sensitive but less specific than lower tricuspid Ea velocities (< 8.5 cm/s) in predicting which patients are at risk of hospitalisation, transplantation, or death.

  • Aa, late diastole
  • DCM, dilated cardiomyopathy
  • Ea, early diastole
  • LVEDD, left ventricular end diastolic dimension
  • LVEF, left ventricular ejection fraction
  • NYHA, New York Heart Association
  • PEP, primary end point
  • RVFAC, right ventricular fractional area change
  • Sa, systole
  • TD, tissue Doppler
  • cardiomyopathy
  • children
  • Doppler
  • prognosis
  • tissue

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