Association Between Left Ventricular Anatomical Dimensions, Cardiac Function, and Response to Diuretic Therapy in Children with Congestive Heart Failure

Abstract

Background: Congenital and acquired cardiac disease can lead to CHF, which is an important cause of morbidity in children. Changes in the dimensions of the left ventricle and in systolic function can affect systemic perfusion, renal blood flow and diuretic response. A transthoracic echocardiogram can assist in the identification of structural and functional features that are associated with therapeutic results.

Objective: To determine the association between left ventricular anatomical dimensions, cardiac function, and response to diuretic therapy in children with congestive heart failure.

Methods: The analytical observational study was cocnducte at Khalifa Gul Nawaz Teaching Hospital MTI Bannu between January 2025 and June 2025. The analysis consisted of 77 children with congestive heart failure. Transthoracic echocardiographic measurements included left ventricular end-diastolic dimension (LVEDD), end-systolic dimension (LVESD), and LVEDD Z score, left ventricular ejection fraction (LVEF), and fractional shortening. The clinical improvement, urine output and length of hospital stay were measured to evaluate diuretic response. Comparisons were made between treatment response-groups and correlation analyses were conducted, where appropriate, and a p<0.05 was regarded as statistically significant.

Results: In the analysis of 77 children, 52 (67.5%) were classified as diuretic responders and 25 (32.5%) as non-responders. Mean LVEF was higher among responders than non-responders (47.0 ± 8.5% versus 36.2 ± 7.3%), while LVEDD Z-score was lower (2.5 ± 1.0 versus 4.1 ± 0.9). Both differences were statistically significant (p<0.001). Higher LVEDD Z-score was associated with longer hospitalization (r=0.475, p<0.001), whereas higher LVEF was associated with shorter hospitalization (r=−0.543, p<0.001).

Conclusion: The analysis suggests that left ventricular enlargement and impaired systolic function may be associated with reduced diuretic responsiveness and prolonged hospitalization in children with congestive heart failure. These potential relationships warrant confirmation using clinical data and standardized treatment-response criteria.