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

Gabriel Hundeshagen, David Herndon, Robert P. Clayton, Paul Wurzer, Alexis McQuitty, Kristofer Jennings, Ludwik Branski, Vanessa N. Collins, Nicole Ribeiro Marques, Celeste Finnerty, Oscar Suman, Michael Kinsky

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Sepsis, trauma, and burn injury acutely depress systolic and diastolic cardiac function; data for long-term cardiac sequelae of paediatric critical illness are sparse. We aimed to assess long-term systolic and diastolic function, myocardial fibrosis, and exercise tolerance in adolescent survivors of severe paediatric burn injury. Methods In this observational study, we prospectively studied consecutive participants (any age or sex) returning to our institution (Shriners Hospitals for Children, Galveston, TX, USA) for long-term follow-up or reconstructive procedures, who had a history of severe paediatric burn injury affecting at least 30% of their total body surface area, sustained the injury at least 5 years before enrolment, and were treated acutely at our institution. 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 (ejection fraction), diastolic function (E/e'), and myocardial fibrosis (calibrated integrated backscatter) of the left ventricle. Exercise tolerance was quantified by oxygen consumption (VO2) 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. Findings Between April 23, 2016, and April 5, 2017, 65 participants (40 post-burn and 25 healthy controls) were eligible for inclusion and were enrolled in the study. At study initiation, post-burn participants were an average age of 19 years (SD 5), were at 12 years (SD 4) post-burn, and had burns over 59% (SD 19) of total body surface area, sustained at 8 years (SD 5) of age. The post-burn group had a lower ejection fraction than healthy controls (ejection fraction 52% [SD 9] vs 61% [6], respectively; p=0·004), and more impaired diastolic function (E/e' 9·8 [SD 2·9] vs 5·4 [0·9]; p<0·0001). Exercise testing showed that burn patients had lower tolerance than the control group (VO2 peak 38 mL/min/kg [SD 12] vs 46 mL/min/kg [8], respectively; p=0·03) and a lower peak heart rate (161 beats per min [bpm; SD 26] vs 182 bpm [13], respectively; p=0·006). In the post-burn group, 11 (29%) individuals had moderate systolic dysfunction and six (15%) had severe systolic dysfunction; 19 (50%) had moderate diastolic dysfunction and eight (21%) had severe diastolic dysfunction; and seven (18%) individuals showed signs of myocardial fibrosis. Interpretation Severe paediatric 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. Funding National Institutes of Health (NIH), National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Shriners Hospitals for Children, Foundation for Anesthesia Education and Research (FAER), and the US Department of Defense.

Original languageEnglish (US)
Pages (from-to)293-301
Number of pages9
JournalThe Lancet Child and Adolescent Health
Volume1
Issue number4
DOIs
StatePublished - Dec 1 2017

Fingerprint

Burns
Critical Illness
Observational Studies
Survivors
Pediatrics
Fibrosis
Exercise Tolerance
Wounds and Injuries
Body Surface Area
Exercise
United States Department of Defense
Heart Rate
Independent Living
National Institutes of Health (U.S.)
Oxygen Consumption
Heart Ventricles
Echocardiography
Sepsis
Anesthesia
Heart Failure

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology

Cite this

Long-term effect of critical illness after severe paediatric burn injury on cardiac function in adolescent survivors : an observational study. / Hundeshagen, Gabriel; Herndon, David; Clayton, Robert P.; Wurzer, Paul; McQuitty, Alexis; Jennings, Kristofer; Branski, Ludwik; Collins, Vanessa N.; Ribeiro Marques, Nicole; Finnerty, Celeste; Suman, Oscar; Kinsky, Michael.

In: The Lancet Child and Adolescent Health, Vol. 1, No. 4, 01.12.2017, p. 293-301.

Research output: Contribution to journalArticle

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abstract = "Background Sepsis, trauma, and burn injury acutely depress systolic and diastolic cardiac function; data for long-term cardiac sequelae of paediatric critical illness are sparse. We aimed to assess long-term systolic and diastolic function, myocardial fibrosis, and exercise tolerance in adolescent survivors of severe paediatric burn injury. Methods In this observational study, we prospectively studied consecutive participants (any age or sex) returning to our institution (Shriners Hospitals for Children, Galveston, TX, USA) for long-term follow-up or reconstructive procedures, who had a history of severe paediatric burn injury affecting at least 30{\%} of their total body surface area, sustained the injury at least 5 years before enrolment, and were treated acutely at our institution. 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 (ejection fraction), diastolic function (E/e'), and myocardial fibrosis (calibrated integrated backscatter) of the left ventricle. Exercise tolerance was quantified by oxygen consumption (VO2) 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. Findings Between April 23, 2016, and April 5, 2017, 65 participants (40 post-burn and 25 healthy controls) were eligible for inclusion and were enrolled in the study. At study initiation, post-burn participants were an average age of 19 years (SD 5), were at 12 years (SD 4) post-burn, and had burns over 59{\%} (SD 19) of total body surface area, sustained at 8 years (SD 5) of age. The post-burn group had a lower ejection fraction than healthy controls (ejection fraction 52{\%} [SD 9] vs 61{\%} [6], respectively; p=0·004), and more impaired diastolic function (E/e' 9·8 [SD 2·9] vs 5·4 [0·9]; p<0·0001). Exercise testing showed that burn patients had lower tolerance than the control group (VO2 peak 38 mL/min/kg [SD 12] vs 46 mL/min/kg [8], respectively; p=0·03) and a lower peak heart rate (161 beats per min [bpm; SD 26] vs 182 bpm [13], respectively; p=0·006). In the post-burn group, 11 (29{\%}) individuals had moderate systolic dysfunction and six (15{\%}) had severe systolic dysfunction; 19 (50{\%}) had moderate diastolic dysfunction and eight (21{\%}) had severe diastolic dysfunction; and seven (18{\%}) individuals showed signs of myocardial fibrosis. Interpretation Severe paediatric 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. Funding National Institutes of Health (NIH), National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Shriners Hospitals for Children, Foundation for Anesthesia Education and Research (FAER), and the US Department of Defense.",
author = "Gabriel Hundeshagen and David Herndon and Clayton, {Robert P.} and Paul Wurzer and Alexis McQuitty and Kristofer Jennings and Ludwik Branski and Collins, {Vanessa N.} and {Ribeiro Marques}, Nicole and Celeste Finnerty and Oscar Suman and Michael Kinsky",
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T1 - Long-term effect of critical illness after severe paediatric burn injury on cardiac function in adolescent survivors

T2 - an observational study

AU - Hundeshagen, Gabriel

AU - Herndon, David

AU - Clayton, Robert P.

AU - Wurzer, Paul

AU - McQuitty, Alexis

AU - Jennings, Kristofer

AU - Branski, Ludwik

AU - Collins, Vanessa N.

AU - Ribeiro Marques, Nicole

AU - Finnerty, Celeste

AU - Suman, Oscar

AU - Kinsky, Michael

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background Sepsis, trauma, and burn injury acutely depress systolic and diastolic cardiac function; data for long-term cardiac sequelae of paediatric critical illness are sparse. We aimed to assess long-term systolic and diastolic function, myocardial fibrosis, and exercise tolerance in adolescent survivors of severe paediatric burn injury. Methods In this observational study, we prospectively studied consecutive participants (any age or sex) returning to our institution (Shriners Hospitals for Children, Galveston, TX, USA) for long-term follow-up or reconstructive procedures, who had a history of severe paediatric burn injury affecting at least 30% of their total body surface area, sustained the injury at least 5 years before enrolment, and were treated acutely at our institution. 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 (ejection fraction), diastolic function (E/e'), and myocardial fibrosis (calibrated integrated backscatter) of the left ventricle. Exercise tolerance was quantified by oxygen consumption (VO2) 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. Findings Between April 23, 2016, and April 5, 2017, 65 participants (40 post-burn and 25 healthy controls) were eligible for inclusion and were enrolled in the study. At study initiation, post-burn participants were an average age of 19 years (SD 5), were at 12 years (SD 4) post-burn, and had burns over 59% (SD 19) of total body surface area, sustained at 8 years (SD 5) of age. The post-burn group had a lower ejection fraction than healthy controls (ejection fraction 52% [SD 9] vs 61% [6], respectively; p=0·004), and more impaired diastolic function (E/e' 9·8 [SD 2·9] vs 5·4 [0·9]; p<0·0001). Exercise testing showed that burn patients had lower tolerance than the control group (VO2 peak 38 mL/min/kg [SD 12] vs 46 mL/min/kg [8], respectively; p=0·03) and a lower peak heart rate (161 beats per min [bpm; SD 26] vs 182 bpm [13], respectively; p=0·006). In the post-burn group, 11 (29%) individuals had moderate systolic dysfunction and six (15%) had severe systolic dysfunction; 19 (50%) had moderate diastolic dysfunction and eight (21%) had severe diastolic dysfunction; and seven (18%) individuals showed signs of myocardial fibrosis. Interpretation Severe paediatric 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. Funding National Institutes of Health (NIH), National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Shriners Hospitals for Children, Foundation for Anesthesia Education and Research (FAER), and the US Department of Defense.

AB - Background Sepsis, trauma, and burn injury acutely depress systolic and diastolic cardiac function; data for long-term cardiac sequelae of paediatric critical illness are sparse. We aimed to assess long-term systolic and diastolic function, myocardial fibrosis, and exercise tolerance in adolescent survivors of severe paediatric burn injury. Methods In this observational study, we prospectively studied consecutive participants (any age or sex) returning to our institution (Shriners Hospitals for Children, Galveston, TX, USA) for long-term follow-up or reconstructive procedures, who had a history of severe paediatric burn injury affecting at least 30% of their total body surface area, sustained the injury at least 5 years before enrolment, and were treated acutely at our institution. 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 (ejection fraction), diastolic function (E/e'), and myocardial fibrosis (calibrated integrated backscatter) of the left ventricle. Exercise tolerance was quantified by oxygen consumption (VO2) 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. Findings Between April 23, 2016, and April 5, 2017, 65 participants (40 post-burn and 25 healthy controls) were eligible for inclusion and were enrolled in the study. At study initiation, post-burn participants were an average age of 19 years (SD 5), were at 12 years (SD 4) post-burn, and had burns over 59% (SD 19) of total body surface area, sustained at 8 years (SD 5) of age. The post-burn group had a lower ejection fraction than healthy controls (ejection fraction 52% [SD 9] vs 61% [6], respectively; p=0·004), and more impaired diastolic function (E/e' 9·8 [SD 2·9] vs 5·4 [0·9]; p<0·0001). Exercise testing showed that burn patients had lower tolerance than the control group (VO2 peak 38 mL/min/kg [SD 12] vs 46 mL/min/kg [8], respectively; p=0·03) and a lower peak heart rate (161 beats per min [bpm; SD 26] vs 182 bpm [13], respectively; p=0·006). In the post-burn group, 11 (29%) individuals had moderate systolic dysfunction and six (15%) had severe systolic dysfunction; 19 (50%) had moderate diastolic dysfunction and eight (21%) had severe diastolic dysfunction; and seven (18%) individuals showed signs of myocardial fibrosis. Interpretation Severe paediatric 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. Funding National Institutes of Health (NIH), National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Shriners Hospitals for Children, Foundation for Anesthesia Education and Research (FAER), and the US Department of Defense.

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