Copyright © 2003 by the European Society of Cardiology.
Cardiomyopathy in children with mitochondrial disease
Clinical course and cardiological findings
a Division of Pediatric Cardiology, The Queen Silvia Children's Hospital, Göteborg, Sweden
b Department of Pathology, Sahlgrenska University Hospital, Göteborg, Sweden
c Department of Clinical Chemistry, Sahlgrenska University Hospital, Göteborg, Sweden
d Department of Pediatrics, The Queen Silvia Children's Hospital, Göteborg, Sweden
Received May 1, 2002;
accepted May 22, 2002
* Corresponding author. Division of Pediatric Cardiology, Department of Pediatrics, The Queen Silvia Children's Hospital, SE-416 85 Göteborg, Sweden. Tel.: +46-31-3434000; fax: +46-31-845029
daniel.holmgren{at}vgregion.se
Aims To determine the frequency of cardiomyopathy in children with mitochondrial disease and describe their clinical course, prognosis and cardiological manifestations.
Methods and results Of 301 children with CNS and neuromuscular disease referred to our institution in 1984 to 1999, 101 had mitochondrial disease. Seventeen patients had cardiomyopathy, diagnosed by echo-Doppler investigations, all of the hypertrophic, non-obstructive type. The onset of symptomatic mitochondrial disease ranged from birth to 10 years of age. Eight children had cytochrome-c oxidase deficiency, while the remaining nine had various defects. Cardiomyopathy was diagnosed from birth to 27 years. Left ventricular posterior wall and septal thickness were both increased: z-scores +4.6±2.6 and +4.3±1.6 (mean±SD), respectively. The left ventricular diastolic diameter z-score, +1.3±3.4, and fractional shortening, 24±13%, displayed marked variations. Nine patients developed heart failure. Eleven patients with cardiomyopathy died, including all eight with cytochrome-c oxidase deficiency, and one patient underwent a heart transplantation. Mortality in children with mitochondrial disease was higher in those with cardiomyopathy (71%) than those without (26%) 
.
Conclusions In children with mitochondrial disease, cardiomyopathy was common (17%) and was associated with increased mortality. The prognosis for children with cytochrome-c oxidase deficiency and cardiomyopathy appeared to be particularly unfavorable.
Key Words: Cardiomyopathy • Children • Mitochondrial disease • Clinical study
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