Prognostic factor of heart failure in children with left-to-right shunt acyanotic congenital heart disease

Main Article Content

Weny Inrianto
Indah K. Murni
Sri Mulatsih
Sasmito Nugroho


Background Anemia is highly prevalent and affects morbidity and mortality in adults with acquired heart disease. However, its role in children with acyanotic congenital heart disease (CHD) is unclear.

Objective To assess anemia and other potential prognostic factors of congestive failure in children with left-to-right shunt acyanotic CHD.

Methods We conducted a case-control study in the Pediatric Cardiology Clinic, Dr. Sardjito Hospital from January to December 2017 in children with left-to-right shunt acyanotic CHD. The case and control groups consisted of subjects with and without heart failure, respectively. Anemia was defined as hemoglobin concentration <11 g/dL. Measured outcome was the prevalence of congestive heart failure, as determined by the Ross criteria. Anemia, defect type, defect size, age at diagnosis, and gender were analyzed by logistic regression analysis as potential predictive factors of heart failure.

Results Of 100 children with left-to-right shunt acyanotic CHD, 50 had heart failure (the case group) and 50 did not (the control group). The prevalence of anemia was 45%. Multivariable logistic regression revealed that defect size was the most significant factor for predicting heart failure, with adjusted OR 7.6 (95%CI 2.5 to 22.8) for moderate shunts and 21.1 (95%CI 6.8 to 65.4) for large shunts. Anemia, type of defect, age of diagnosis, and gender were not statistically significant factors for predicting outcomes.

Conclusion Anemia is not a significant, prognostic factor for heart failure in children with left-to-right shunt acyanotic CHD. However, moderate and large shunts in children with left-to-right shunt acyanotic CHD are predictive of the occurrence of congestive heart failure.

Article Details

How to Cite
Inrianto W, Murni I, Mulatsih S, Nugroho S. Prognostic factor of heart failure in children with left-to-right shunt acyanotic congenital heart disease. PI [Internet]. 13Mar.2019 [cited 11Aug.2020];59(2):63-. Available from:
Pediatric Cardiology
Received 2019-01-20
Accepted 2019-02-28
Published 2019-03-13


1. WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization; 2011 (WHO/NMH/NHD/MNM/11.1). [cited 2018 March 17]. Avalilable at
2. Dimopoulos K, Diller GP, Giannakoulas G, Petraco R, Chamaidi A, Karaoli E, et al. Anemia in adults with congenital heart disease relates to adverse outcome. J Am Coll Cardiol. 2009;54:2093–100.
3. Mueller GC, Schlueter EL, Arndt F, Dodge-Khatami A, Weil J, Mir TS. Prevalence of anemia in children with congestive heart failure due to dilated cardiomyopathy. Int J Pediatr. 2012;2012:1-4.
4. Ross RD. The Ross classification for heart failure in children after 25 years: a review and an age-stratified revision. Pediatr Cardiol. 2012;33:1295–300.
5. Hariyanto D. Profil penyakit jantung bawaaan di instalasi Rawat Inap Anak RSUP Dr. M. Djamil Padang Januari 2008-Februari 2011. Sari Pediatr. 2012;14:152–7.
6. Badan Penelitian dan Pengembangan Kesehatan. Riset Kesehatan Dasar (RISKESDAS) 2013. Jakarta: Kemenkes RI; 2013.p. 1-384.
7. Okoromah CA, Ekure EN, Lesi FEA, Okunowo WO, Tijani BO, Okeiyi JC. Prevalence, profile and predictors of malnutrition in children with congenital heart defects: a case-control observational study. Arch Dis Child. 2011;96:354–60.
8. van der Meer P, van Veldhuisen DJ. Anaemia and renal dysfunction in chronic heart failure. Heart. 2009;95:1808–12.
9. Burchill LJ, Ross HJ, Opotowsky AR. Heart failure in adults with congenital heart disease. In: Jefferies JL, AC, Rossano JW, Shaddy RE, Towbin JA, editors. Heart failure in the child and young adult. London: Elsevier; 2018. p. 331-52.
10. Jayaprasad N. Heart failure in children. Heart Views. 2016;17:92.