Prognosis of Pediatric Dilated Cardiomyopathy: Nomogram and Risk Score Models for Predicting Death/Heart Transplantation

TL;DR

This study created a model to predict the risk of death or heart transplantation in children with dilated cardiomyopathy using clinical factors.

Contribution

The study introduces a novel nomogram and risk score model for predicting outcomes in pediatric dilated cardiomyopathy.

Findings

Age of onset, cardiac classification III–IV, and mitral regurgitation are key predictors of D/HT risk.

The nomogram achieved 80.3% sensitivity and 66.7% specificity in predicting D/HT.

A scoring system with a cutoff of ≥13.25 improved prediction accuracy to 68.9% sensitivity and 73.9% specificity.

Abstract

Background: This study aimed to develop a predictive model to assess risk factors and prognoses in pediatric patients with dilated cardiomyopathy (DCM). Methods: A total of 233 pediatric patients with DCM who were hospitalized between January 2019 and June 2024 were enrolled. The children were followed up and categorized into two groups: the death/heart transplantation (D/HT) group and the non-D/HT group. Univariate and multivariate analyses identified risk factors. A nomogram model and a scoring system were developed. The performance of these models was evaluated using the H-L test, ROC analysis, and internal validation. Results: The results demonstrated that the age of onset, cardiac functional classification III–IV, moderate-to-severe mitral regurgitation, low voltage in limb leads on an ECG, and the need for vasoactive drugs are independent predictors of D/HT risk in children with DCM. A nomogram model was developed, achieving an AUC of 0.804 (95% CI: 0.734–0.874), a sensitivity of 80.3%, and a specificity of 66.7%. A scoring system was established: 1 point for age of onset, 10 points for cardiac functional classification III–IV, 2.5 points for moderate-to-severe mitral regurgitation, 4 points for low voltage in limb leads on an ECG, 3 points for the need for vasoactive drugs, or 0 points if none of these criteria were met. When the cumulative score was ≥ 13.25, the sensitivity and specificity increased to 68.9% and 73.9%, respectively. Conclusions: We developed both a nomogram and a scoring system model, which are capable of rapidly and accurately predicting the risk of D/HT in children with DCM.

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