Clinical and Echocardiographic Criteria for the Diagnosis of Dilated Cardiomyopathy in Children

Abstract

Dilated cardiomyopathy (DCM) and non-rheumatic carditis in children share an overlapping clinical presentation and are frequently indistinguishable at the bedside, yet they differ fundamentally in treatment strategy and prognosis. The aim of the study was to identify the clinical, laboratory and echocardiographic parameters that reliably discriminate between these two conditions. A retrospective comparative study included 40 children: 31 with DCM (main group) and 9 with non-rheumatic carditis (comparison group). Seventy-four parameters were analysed, covering anthropometry, clinical findings, vital signs, electrocardiography, echocardiography, chest radiography and laboratory data. Body mass index-for-age Z-scores were calculated using the WHO LMS method. Non-parametric statistics were applied (Mann-Whitney U test, Fisher exact test, Spearman rank correlation). The groups were comparable in age, body weight, height, body mass index and Z-score (all p > 0.05). Significant between-group differences were found for cyanosis (90.3 % vs 33.3 %, p = 0.001), oxygen saturation (95.84 +/- 1.66 % vs 97.33 +/- 0.87 %, p = 0.003), left ventricular ejection fraction (35.52 +/- 14.06 % vs 55.17 +/- 7.14 %, p = 0.007), heart rate (p = 0.025), tricuspid regurgitation (40.7 % vs 0 %, p = 0.037) and total serum protein (p = 0.037). An ejection fraction below 45 % was recorded in 74.2 % of children with DCM and in none of the comparison group. Conventional clinical signs of myocardial involvement and inflammatory laboratory markers showed no discriminative value. Correlation analysis revealed a consistent association between anemia and haemodynamic burden in DCM