April

Environmental and Socioeconomic Factors Influence the Live-Born Incidence of Congenital Heart Disease: A Population-Based Study in California.

[et_pb_section fb_built="1" admin_label="section" _builder_version="3.22"][et_pb_row admin_label="row" _builder_version="3.25" background_size="initial" background_position="top_left" background_repeat="repeat"][et_pb_column type="4_4" _builder_version="3.25" custom_padding="|||" custom_padding__hover="|||"][et_pb_text admin_label="Text" _builder_version="4.7.4" background_size="initial" background_position="top_left" background_repeat="repeat" hover_enabled="0" sticky_enabled="0"]Environmental and Socioeconomic Factors Influence the Live-Born Incidence of Congenital Heart Disease: A Population-Based Study in California. Peyvandi S, Baer RJ, Chambers CD, Norton ME, Rajagopal S, Ryckman KK, Moon-Grady A, Jelliffe-Pawlowski LL, Steurer MA. J Am Heart Assoc. 2020 Apr 21;9(8):e015255. doi: 10.1161/JAHA.119.015255. Epub 2020 Apr 19. Take Home Points Adverse social and environmental factors at the neighborhood level may play an important role in the development of congenital heart disease (CHD). Worse social deprivation index (SDI) (6 measures of wealth and income) and environmental exposure index (EEI) (levels of exposure to pollutants) quartiles had higher odds of CHD. Maternal comorbidities explain some, but not all, of this socio-environmental relationship with development of CHD. Commentary from Dr. Clifford Cua (Columbus, OH), Section Editor of Pediatric Cardiology Journal Watch:   The California Office of Statewide Health Planning and Development database was used to obtain data on newborn patients born between 2007 – 2012.  Maternal and infant data are linked in this database and ICD-9 codes were used for diagnostic classification.  Significant congenital heart disease (CHD) was defined as a defect that would require surgery within the 1st year of life.  A social deprivation index (SDI) (6 measures of wealth and income) and environmental exposure index (EEI) (levels of exposure to pollutants) were determined at the neighborhood level.  Z-scores for both indexes were obtained for each patient and scores were categorized into 4 quartiles, with 1st quartile being the most ideal situation and 4th quartile being the least ideal situation. Hierarchical logistic regression was used to determine the association between the main predictors and the primary outcome after adjustment for maternal factors and age of cohort.  Sensitivity analysis was conducted to determine the relationship after excluding single ventricle diagnosis in regions with high prenatal diagnosis.  A mediation analysis was used to test if maternal comorbidities may be in the causal pathway of SDI and EEI. During the time period studied, over 2 million live births were included in the study.  All individual sociodemographic and environmental factor Z-scores were worse for in the CHD group (7698 infants with CHD studied) compared to the controls.  The odds of live-born CHD were significantly higher among those with increasing SDI and EEI quartile.  Odds were also significantly higher in mothers with comorbidities to have a child with CHD.  These odds still were significant when excluding infants with known chromosomal abnormalities/syndromes (6120 infants with CHD studied).  Odds were also still significant when excluding single ventricle patients to take into account possible bias when evaluating just live-born births.  Odds were 1.48 (1.32 – 1.66) higher for having a child with CHD for those in the 4th quartile versus those in the 1st quartile.  Causal mediation analysis showed that 13% (95% CI, 10 – 20%) of the total effect of SDI/EEI on the incidence of CHD is mediated through the presence of maternal comorbidities with race/ethnicity as confounders in the relationship between maternal conditions and incidence of CHD. As the authors stated, this study is limited by the use of an administrative database where errors in entry may occur, ~20% of data were excluded due to incomplete data, only live-born infants were evaluated thus true incidence of CHD may be under-reported due to fetal demise/termination, misclassification of pollutants, and no data on timing of exposure to pollutants. Despite these limitations, this is a large database study that provides intriguing data suggesting how multifactorial variables may play a role in the development of CHD.  Improving the socioeconomic welfare and decreasing pollutant exposure may be another method to decrease the incidence of CHD in the overall population.       [/et_pb_text][/et_pb_column][/et_pb_row][/et_pb_section]

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Value of Exercise Stress Echocardiography in Children with Hypertrophic Cardiomyopathy.

Value of Exercise Stress Echocardiography in Children with Hypertrophic Cardiomyopathy. El Assaad I, Gauvreau K, Rizwan R, Margossian R, Colan S, Chen MH. J Am Soc Echocardiogr. 2020 Apr 9. pii: S0894-7317(20)30067-5. doi: 10.1016/j.echo.2020.01.020. [Epub ahead of print] PMID: 32279939 Similar articles Select item 32271829   Take Home Points Exercise stress echocardiography (ESE) is a safe and feasible modality in children with hypertrophic cardiomyopathy. In children without rest LVOT gradient 44% develop gradients > 30 mm Hg with exercise. ESE-derived rest and exercise gradients correlated with risk of cardiac outcome. Children with LVOT gradients <30 mm Hg have lowest risk of CV events. Children with LVOT gradients ≥30 mm Hg have 5 times the risk of CV events.   Comment from Dr. Jennifer Johnson (Pittsburgh, PA), Section Editor of Pediatric Cardiology Journal Watch:   This is a single center retrospective chart review of all pediatric hypertrophic cardiomyopathy patients who underwent exercise stress echocardiography to determine if exercise stress echocardiography can be useful in risk stratifying hypertrophic cardiomyopathy subgroups and if LVOT obstruction occurs in the patients with nonobstructive hypertrophic cardiomyopathy. Methods:  Data was collected on all pediatric hypertrophic cardiomyopathy patient who underwent exercise stress echocardiography from 2007-2018 at Boston Children’s Hospital.  Subjects were assigned to one of three categories based on left ventricular outflow tract gradients: group 1: <30 mm Hg at rest and exercise; group 2: <30 mm Hg at rest and ≥30 mm Hg with exercise; and group 3: ≥ 30 mm Hg at rest and exercise. The composite adverse endpoints on follow-up included heart transplant, aborted cardiac arrest, and sudden cardiac death. Results:  A total of 91 (61% male), median age 12 years (6-24 years) with hypertrophic cardiomyopathy underwent exercise stress echocardiography; baseline patient characteristics are described in table 1.  Median left ventricle wall thickness was 20 mm and median follow-up duration was 3 years. During ESE, only one child experienced an event and was resuscitated. Of the 91 children, 25 were classified as group 1, 40 as group 2, and 26 as group 3. Twenty-six patients met the composite endpoint, including two heart transplant, one aborted cardiac arrest, and one sudden cardiac death. Group 3 patients had a 5 times higher risk of developing symptoms and/or serious clinical outcome at any age (hazard ratio = 5.18; 95% CI, [1.39-19.2]; P = .014). During our short follow-up time, group 2 patients had a higher risk of outcome, but this did not achieve statistical significance (hazard ratio = 1.95; 95% CI, [0.5-7.6]; P = .33). Exercise stress echocardiography data; table 2.  Of the 40 patients in group 2 (resting LVOT <30 mmHg, exercise LVOT gradient ³ 30 mmHg) 20 had obstruction due to septal hypertrophy/systolic anterior motion, 13 patients mid cavitary obstruction and other 7 patients had a mixed obstruction etiology. Of the total cohort, 73 (80%) subjects  were free of cardiac events prior to the first exercise stress echocardiogram study.  In the 3 year follow up data 26 patients had 31 cardiac events. Discussion: In this cohort, 90 (99%) patients had an event-free exercise stress echocardiogram with one group 3 patient experiencing a fast-polymorphic ventricular fibrillation arrest requiring resuscitation during exercise stress test.  This data showed pediatric exercise stress echocardiogram for hypertrophic cardiomyopathy can be performed safely with low risk to the patients.        

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Incidence and fate of device-related left pulmonary artery stenosis and aortic coarctation in small infants undergoing transcatheter patent ductus arteriosus closure.

Incidence and fate of device-related left pulmonary artery stenosis and aortic coarctation in small infants undergoing transcatheter patent ductus arteriosus closure. Tomasulo CE, Gillespie MJ, Munson D, Demkin T, O'Byrne ML, Dori Y, Smith CL, Rome JJ, Glatz AC....

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