Real-World Use of Carvedilol in Children With Dilated Cardiomyopathy: Long-Term Effect on Survival and Ventricular Function

Frontiers in Pediatrics

article

Rachele Adorisio¹  Nicoletta Cantarutti²  Marco Ciabattini³  Antonio Amodeo¹  Fabrizio Drago² 

[1] Advanced Cardiovascular Therapies, Department of Cardiology, Cardiac Surgery, Heart and Lung Transplant, Bambino Gesù Children Hospital and Research Institute;Pediatric Cardiology and Arrhythmias/Syncope Units, Department of Cardiology, Cardiac Surgery, Heart and Lung Transplant, Bambino Gesù Children Hospital and Research Institute;Clinical Trial Center, University Department of Pediatrics, Bambino Gesù Children Hospital and Research Institute

关键词: β-blockers;    carvedilol;    dilated cardiomyopathy;    children;    heart failure;   

DOI  :  10.3389/fped.2022.845406

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background Carvedilol is recommended for chronic heart failure (HF) treatment in children. However, the ideal dosage and administration are not standardized, and data on its long-term effects are lacking. This study aimed to assess the effect of a high dosage regimen of carvedilol on cardiac outcomes in children with HF. Methods We conducted a retrospective cohort study including all children with HF and dilated cardiomyopathy. We analyzed medical records before starting treatment, at 1 and 3 years after reaching the maximum therapeutic dosage. All data were compared with a historical control group. Kaplan–Meier analysis and Cox proportional hazard regression have been used to evaluate the effect of high dosage carvedilol therapy. The main outcome was a composite of all-cause mortality and heart transplant. Results One hundred thirty-five were included in the study and 65 treated with a high dosage of carvedilol regimen (up to 1 mg/kg/day). Heart rate reduction (mean reduction 30%, p < 0.0001) and ejection fraction improvement (32 ± 9.4 vs. 45. ± 10.1%, p < 0.0001) were statistically significant in those. Long-term survival and freedom from heart transplant were significantly improved in those treated with high dosage carvedilol therapy ( p = 0.00001). Conclusions Treatment with the high dosage of carvedilol, in addition to standard HF therapy, significantly improves ventricular function and survival in children with dilated cardiomyopathy and chronic HF.

【 授权许可】

CC BY