Heart Failure Clinical Trial
Official title:
Evaluation of Severity of Heart Failure in Children Attending Cardiology Unit, Assiut University Children Hospital
Evaluation of Severity of Heart Failure in Children Attending Cardiology Unit, Assiut University Children Hospital
Heart failure (HF) has been defined as an abnormality of cardiac structure or function
leading to failure of the heart to deliver oxygen at a rate commensurate with the
requirements of the metabolizing tissues, despite normal filling pressures (or only at the
expense of increased filling pressures). Heart failure may result from ventricular pump
dysfunction, volume overload with preserved pump function, and pressure overload with
preserved pump function.Determinations of the degree of heart failure severity are essential
for clinical assessment and treatment evaluation. Remarkably, no readily applied standardized
method of quantifying heart failure severity exists for pediatric patients. Although standard
index methods from the adult population, such as the New York Heart Association
Classification, have been applied to non-infant pediatric populations, none have been
validated in children. The NYHA classification measures functional capacity, not heart
failure severity. The NYHA classification is inappropriate for use in pediatrics because
functional capacity and responses to heart failure states differ in children compared with
adults. Children have markedly different cardiac physiology, clinical presentations, and
compensatory mechanisms. Moreover, the etiologies of heart failure in children are very
different from those in adults. For these reasons, Ross et al.,developed a scale that is
useful for grading heart failure severity in infants from birth to 6 months of age but is not
applicable to older children and adolescents (Original Ross Classification).
Many have since used the "Ross Classification," including Wu et al., who confirmed an
incremental rise in PNE (Plasma Norepinephrine) concentrations and progressive
down-regulation of β-receptor density in children with increasing Ross class. In 1994, the
Canadian Cardiovascular Society's Consensus Conference statement on the "Diagnosis and
Management of Heart Failure," adopted the Ross Classification as their official scoring
system for children. Ross propose an age-based Ross classification using the original
variables that proved to be sensitive and specific and adding the new evidence-based data.
The age ranges of 0-3 months, 4-12 months, 1-3 years, 4-8 years, and 9-18 years were chosen
because the variables in the classification are generally stable during these periods but
vary between them. The scoring system can be used as a continuous data set for comparison
with outcomes, or it can be categorized by points.
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