Long-term effect of critical illness after severe paediatric burn injury on cardiac function in adolescent survivors: An observational study

Model System:

Burn

Reference Type:

Journal article

Accession No.:

J81120

Journal:

The Lancet. Child and Adolescent Health

Year, Volume, Issue, Page(s):

2017 , 1, 4, 293-301

Publication Website:

Abstract:

Study assessed long-term systolic and diastolic function, myocardial fibrosis, and exercise tolerance in adolescent survivors of severe pediatric burn injury. Sixty-five participants (40 post-burn and 25 healthy controls) were enrolled in the study. At study initiation, post-burn participants were an average age of 19 years, were at 12 years post-burn, and had burns over 59 percent of total body surface area, sustained at 8 years of age. Age-matched healthy controls were individuals who underwent echocardiographic evaluation for systolic and diastolic function as well as exercise testing during the same time period at the institution. Participants underwent echocardiography to quantify systolic function, diastolic function, and myocardial fibrosis (calibrated integrated backscatter) of the left ventricle. Exercise tolerance was quantified by oxygen consumption and heart rate at rest and during peak exercise. Demographic information, clinical data, and biomarker expression were used to predict long-term cardiac dysfunction and fibrosis. The post-burn group had a lower ejection fraction than healthy controls (52 vs 61 percent, respectively), and more impaired diastolic function (9.8 vs 5.4). Exercise testing showed that burn patients had lower tolerance than the control group and a lower peak heart rate. In the post-burn group, 11 (29 percent) individuals had moderate systolic dysfunction and six (15 percent) had severe systolic dysfunction; 19 (50 percent) had moderate diastolic dysfunction and eight (21 percent) had severe diastolic dysfunction; and seven (18 percent) individuals showed signs of myocardial fibrosis. Severe pediatric burn injury might have lasting effect on cardiac function into late adolescence and is associated with myocardial fibrosis and reduced exercise tolerance. Given the strong predictive value of systolic and diastolic dysfunction, these patients might be at increased risk of early heart failure, associated morbidity, and mortality.

Author(s):