Skip to main content

Advertisement

SpringerLink
Log in

The Effect of Carvedilol Treatment on Chronic Heart Failure in Pediatric Patients With Dilated Cardiomyopathy: A Prospective, Randomized-Controlled Study

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

This study aimed to evaluate the clinical efficacy and safety of carvedilol for pediatric patients with chronic heart failure caused by dilated cardiomyopathy. Seven pediatric medical centers participated in this prospective study. Pediatric patients (n = 89) were randomly divided into an experimental group (carvedilol treatment) and a control group (conventional treatment). The analysis excluded 12 patients lost during the follow-up period. Carvedilol was added to the therapy of the experimental group after at least 1 month of basic treatment with digoxin, an angiotensin-converting-enzyme inhibitor, and diuretics. The control patients received the same basic treatment but did not receive carvedilol. The initial dose of carvedilol was 0.1 (mg/kg day), and the dose was doubled every 2 weeks until the maximum tolerated dose or 0.8 (mg/kg day) was achieved. The tolerated dose was maintained for 6 months. The Ross scales and echocardiographic parameters including left ventricular diastolic diameter, left ventricular systolic diameter, left ventricular ejection fraction, left ventricular fractional shortening, and serous brain natriuretic peptide (BNP) concentration, as well as clinical progress were compared between the two groups. The Ross scales decreased by 11.94 % in the experimental group, which was more than in the control group (2.81 %). In addition, changes to other echocardiographic parameters in the experimental group also were superior to those in the control group. The serous BNP concentration in the experimental group decreased by 30.1 %, which also was more than the decrease (22.2 %) observed in the control group. Clinical improvement was demonstrated by 40 %, no change by 35 %, and clinical deterioration by 25 % of the patients in the experimental group, and by respectively 37.8, 27, and 35.2 % of the patients in the control group. These differences were not statistically significant. Only one patient demonstrated a severe adverse event, severe pulmonary infection, and complete atrioventricular block. None of the other carvedilol-treated patients experienced drug-related side effects. Carvedilol can be safely used for treatment of chronic heart dysfunction in pediatric patients with dilated cardiomyopathy. The results in this study showed an apparent improvement in the cardiac function of these patients. Additional clinical studies are required to determine the most favorable dosing levels and regimens of carvedilol before its safety and efficacy for the pediatric population can be determined conclusively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Auslender M, Artman M (2000) Overview of the management of pediatric heart failure. Prog Pediatr Cardiol 11:231–241

    Article  PubMed  Google Scholar 

  2. Azeka E, Franchini Ramires JA, Valler C, Alcides Bocchi E (2002) Delisting of infants and children from the heart transplantation waiting list after carvedilol treatment. J Am Coll Cardiol 40:2034–2038

    Article  PubMed  CAS  Google Scholar 

  3. Blume ED, Canter CE, Spicer R, Gauvreau K, Colan S, Jenkins KJ (2006) Prospective single-arm protocol of carvedilol in children with ventricular dysfunction. Pediatr Cardiol 27:336–342

    Article  PubMed  CAS  Google Scholar 

  4. Bruns LA, Chrisant MK, Lamour JM, Shaddy RE, Pahl E, Blume ED, Hallowell S, Addonizio LJ, Canter CE (2001) Carvedilol as therapy in pediatric heart failure: an initial multicenter experience. J Pediatr 138:505–511

    Article  PubMed  CAS  Google Scholar 

  5. Giardini A, Formigari R, Bronzetti G, Prandstrller D, Donti A, Bonvicini M, Picchio FM (2003) Modulation of neurohormonal activity after treatment of children in heart failure with carvedilol. Cardiol Young 13:333–336

    PubMed  Google Scholar 

  6. Kalinowski L, Dobrucki LW, Szczepanska-Konkel M, Jankowski M, Martyniec L, Angielski S, Malinski T (2003) Third-generation beta-blockers stimulate nitric oxide release from endothelial cells through ATP efflux: a novel mechanism for antihypertensive action. Circulation 107:2747–2752

    Article  PubMed  CAS  Google Scholar 

  7. Läer S, Mir TS, Behn F, Eiselt M, Scholz H, Venzke A, Meibohm B, Weil J (2002) Carvedilol therapy in pediatric patients with congestive heart failure: a study investigating clinical and pharmacokinetic parameters. Am Heart J 143:916–922

    Article  PubMed  Google Scholar 

  8. Lechat P, Packer M, Chalon S, Cucherat M, Arab T, Boissel JP (1998) Clinical effects of beta-adrenergic blockade in chronic heart failure: a meta analysis of double-blind, placebo-controlled, randomized trials. Circulation 98:1184–1191

    Article  PubMed  CAS  Google Scholar 

  9. Li R, Yi QJ, Qian YR, Liu XY, Zhong JR, Bai YH, Mi Q, Li XL (2008) Preliminary study on the effect of carvedilol on children with primary endocardial fibroelastosis. Zhonghua Er Ke Za Zhi 46:684–687

    PubMed  Google Scholar 

  10. Matitiau A, Perez-Atayde A, Sanders SP et al (1994) Infantile dilated cardiomyopathy: relation of outcome to left ventricular mechanics, hemodynamic, and histology at the time of presentation. Circulation 90:1310–1318

    Article  PubMed  CAS  Google Scholar 

  11. Nakamura K, Kusano K, Nakamura Y, Kakishita M, Ohta K, Nagase S, Yamamoto M, Miyaji K, Saito H, Morita H, Emori T, Matsubara H, Toyokuni S, Ohe T (2002) Carvedilol decrease elevated oxidative stress in human failing myocardium. Circulation 105:2867–2871

    Article  PubMed  CAS  Google Scholar 

  12. Rusconi P, Gomez-Marin O, Rossique-Gonzalez M, Redha E, Marin JR, Lon-Young M, Wolff GS (2004) Carvedilol in children with cardiomyopathy: 3-year experience at a single institution. J Heart Lung Transplant 23:832–838

    Article  PubMed  Google Scholar 

  13. Sabbah HN (2000) Apoptotic cell death in heart failure. Cardiovasc Res 45:704–712

    Article  PubMed  CAS  Google Scholar 

  14. Shaddy RE (1998) Beta-blocker therapy in young children with congestive heart failure under consideration for heart transplantation. Am Heart J 136:19–21

    Article  PubMed  CAS  Google Scholar 

  15. Shaddy RE, Boucek MM, Hsu DT, Boucek RJ, Canter CE, Mahony L, Ross RD, Pahl E, Blume ED, Dodd DA, Rosenthal DN, Burr J, LaSalle B, Holubkov R, Lukas MA, Tani LY, Pediatric Carvedilol Study Group (2007) Carvedilol for children and adolescents with heart failure. JAMA 298:1171–1179

    Article  PubMed  Google Scholar 

  16. Toyono M, Kondo C, Nakajima Y, Nakazawa M, Momma K, Kusakabe K (2001) Effects of carvedilol on left ventricular function, mass, and scintigraphic findings in isolated left ventricular non-compaction. Heart 86:e4

    Article  PubMed  CAS  Google Scholar 

  17. Williams RV, Tani LY, Shaddy RE (2002) Intermediate effects of treatment with metoprolol or carvedilol in children with left ventricular systolic dysfunction. J Heart Lung Transplant 21:906–909

    Article  PubMed  Google Scholar 

  18. Yoshikawa T, Port JD, Asano K, Chidiak P, Bouvier M, Dutcher D, Roden RL, Minobe W, Tremmel KD, Bristow MR (1996) Cardiac adrenergic receptor effects of carvedilol. Eur Heart J 17:8–16

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Cardiology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University, 1678, Dongfang Road, Shanghai, 200127, People’s Republic of China

    Meirong Huang, Xu Zhang & Shubao Chen

  2. Qingdao Children’s Hospital, Qingdao, People’s Republic of China

    Yuping Sun

  3. Beijing An’zhen Hospital, Beijing, People’s Republic of China

    Yanyan Xiao

  4. No. 1 Hospital Affiliated to Jilin University, Jilin, People’s Republic of China

    Jinghui Sun

  5. Shanghai Children’s Hospital, Shanghai, People’s Republic of China

    Min Huang

  6. Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China

    Sun Chen

  7. Children’s Hospital of Fudan University, Shanghai, People’s Republic of China

    Fang Liu

Authors
  1. Meirong Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xu Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shubao Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuping Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yanyan Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jinghui Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Min Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sun Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Fang Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shubao Chen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Huang, M., Zhang, X., Chen, S. et al. The Effect of Carvedilol Treatment on Chronic Heart Failure in Pediatric Patients With Dilated Cardiomyopathy: A Prospective, Randomized-Controlled Study. Pediatr Cardiol 34, 680–685 (2013). https://doi.org/10.1007/s00246-012-0527-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-012-0527-x

Keywords

Search

Navigation