Clinical characteristics and outcomes of children with dilated cardiomyopathy in a tertiary cardiac center: a five-year review

Abstract

Background: Dilated cardiomyopathy (DCM) represents the commonest form of cardiomyopathy in children, significantly contributing to morbidity and mortality among those affected. Nevertheless, in developing countries, there is still limited published data on DCM, especially in the pediatric population. Therefore, this study aimed to document the clinical characteristics and treatment outcomes of children with DCM. Methods: This was a retrospective study of children with DCM admitted to the Jakaya Kikwete Cardiac Institute (JKCI) from January 2021 through December 2025. Socio-demographics, clinical characteristics, and survival data were extracted from the medical records. Frequencies and proportions were calculated for categorical variables. The mean with standard deviation (SD) and median with an interquartile range (IQR) were calculated for continuous data. Results: In a period of 5 years, out of 3,330 admissions, data from 35 children (1.1% 95% CI 0.73-1.46) diagnosed with DCM were analyzed. Two-thirds (68.6%) were aged below 5 years, with a slight predominance of male children. The most frequent known causes of DCM were previous clinical diagnosis of myocarditis, 42.9% (15/35), followed by arrhythmias, 14.3% (5/35), with a median age at diagnosis of 20 months (IQR, 8-60). The median left ventricular ejection fraction (LVEF) at the time of diagnosis was 30% (IQR, 25-39). During the hospital stay, 14.3% (5/35) of children developed complications; two children had a stroke while three developed acute kidney injury (AKI). The median follow-up time during clinic visits was 18 months, with a maximum time of 5 years and 9 months. At the follow-up clinic, 25% of children (7/28) recovered to normal heart function, while 35.7% (10/28) of children had unchanged LVEF. A total of nine children died; three (8.6% 95% CI 1.8-23.06) were in-hospital, and 6 (21.4% 95% CI 8.3-40.95) post-discharge. Five children (14.3%) were re-hospitalized due to exacerbation of heart failure. Conclusion: Children aged below 5 years were largely affected in our cohort, with clinically diagnosed myocarditis as the most common underlying cause. A quarter of the children showed complete recovery of heart function during the follow-up visits. We observed mortality and in-hospital complications such as stroke and AKI. Further studies involving genetic screening for the unknown etiologies of DCM are highly recommended.