DILATED CARDIOMYOPATHY IN CHILDREN: A RETROSPECTIVE STUDY OF 25 CASES

Background: Dilated cardiomyopathy (DCM) is the most common cardiomyopathy in children and represents a major cause of heart failure and an important indication for cardiac transplantation. Objective: To describe the epidemiological, clinical, echocardiographic, etiological, and therapeutic characteristics of pediatric DCM cases managed at the Children’s Hospital of Rabat. Methods: We conducted a retrospective review of medical records of patients aged 1 month to 16 years diagnosed with DCM in the Department of Pediatrics 4 at the Children’s Hospital of Rabat, from January to December 2024. Inclusion criteria were left ventricular (LV) dilatation (end-diastolic dimension z-score > +2) associated with systolic dysfunction (ejection fraction and/or fractional shortening z-score < –2). Results: Twenty-five patients were included (14 females, 11 males). The mean age at diagnosis was 37.7 months (range 2–100), with 80% diagnosed before 6 years of age. Clinical heart failure was present in 71% of cases, including 27% with stage IV. Etiology was identified in 44%: myocarditis (20%), Duchenne muscular dystrophy (8%), primary carnitine deficiency (4%), anthracycline-induced (4%), and congenital heart disease with associated myocarditis or hemodynamic overload (20%). In 56%, etiology remained idiopathic. Standard heart failure therapy was administered in all patients. Two deaths occurred during hospitalization, while 10 patients improved, 5 were lost to follow-up, and 8 showed progressive LV dysfunction. Conclusion: Pediatric DCM is a heterogeneous disease with high morbidity and mortality. In our setting, myocarditis and genetic or metabolic disorders were leading identifiable causes, but more than half remained idiopathic. Multidisciplinary management, genetic counseling, and long-term follow-up are essential.