1. Incidence, risk factors, and mortality of neonatal and late-onset dilated cardiomyopathy associated with cardiac neonatal lupus
- Author
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Christophe Deligny, Francois Barriere, P. Orquevaux, Eric Hachulla, Olivier Fain, Delphine Le Mercier, Philippe Ravaud, Jérôme Le Bidois, Bénédicte Romefort, Sophie Georgin-Lavialle, Claire Le Jeunne, Gaëlle Guettrot-Imbert, Francois Sassolas, Elisabeth Villain, Luc Mouthon, Nathalie Costedoat-Chalumeau, Laurent Fermont, Alice Maltret, Quentin Hauet, Mohamed Hamidou, Jean-Charles Piette, Gabriel Baron, Kateri Levesque, Damien Bonnet, Arnaud Theulin, and Nathalie Morel
- Subjects
Adult ,Cardiomyopathy, Dilated ,Male ,Cardiac function curve ,medicine.medical_specialty ,Adolescent ,030204 cardiovascular system & hematology ,complex mixtures ,Pericardial effusion ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Humans ,Lupus Erythematosus, Systemic ,Medicine ,Registries ,cardiovascular diseases ,Age of Onset ,Mortality ,Child ,Retrospective Studies ,030203 arthritis & rheumatology ,business.industry ,Incidence ,Mortality rate ,Infant, Newborn ,Infant ,Endocardial fibroelastosis ,Dilated cardiomyopathy ,musculoskeletal system ,medicine.disease ,In utero ,Child, Preschool ,cardiovascular system ,Cardiology ,Female ,Age of onset ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Follow-Up Studies - Abstract
Background Dilated cardiomyopathy (DCM), a well-known complication of cardiac neonatal lupus, is associated with high mortality rate. Its risk factors remain unclear. Methods We analyzed occurrence of postnatal DCM among children with high-degree congenital heart block (CHB) and mothers with anti-SSA and/or anti-SSB antibodies. Results Among 187 neonates with CHB, 35 (18.8%, one missing data) had DCM and 22 (11.8%) died during a median follow-up of 7years [range: birth–36years]. On multivariate analysis, factors associated with postnatal DCM were in utero DCM ( P =0.0199; HR=3.13 [95% CI: 1.20–8.16]), non-European origin ( P =0.0052; HR=4.10 [95% CI: 1.81–9.28]) and pacemaker implantation ( P =0.0013; HR=5.48 [95% CI: 1.94–15.47]). Postnatal DCM could be categorized in two subgroups: neonatal DCM (n=13, diagnosed at a median age of 0day [birth–4days]) and late-onset DCM (n=22, diagnosed at a median age of 15.2months [3.6months–22.8years]). Factors associated with neonatal DCM were in utero DCM, hydrops, endocardial fibroelastosis and pericardial effusion, whereas those associated with late-onset DCM were non-European origin, in utero mitral valve insufficiency, and pacemaker implantation. Fluorinated steroids showed no protective effect against late-onset DCM ( P =0.27; HR=1.65 [95% CI: 0.63–4.25]). Probability of survival at 10years was 23.1% for newborns diagnosed neonatally with DCM, 53.9% for those who developed late-onset DCM, and 98.6% for those without DCM. Conclusion Neonatal and late-onset DCM appear to be two different entities. None of the known risk factors associated with neonatal DCM predicted late-onset DCM. Long-term follow-up of cardiac function is warranted in all children with CHB.
- Published
- 2017