Carvedilol as therapy in pediatric heart failure: An initial multicenter experience

被引:109
作者
Bruns, LA
Chrisant, MK
Lamour, JM
Shaddy, RE
Pahl, E
Blume, ED
Hallowell, S
Addonizio, LJ
Canter, CE
机构
[1] Washington Univ, St Louis Childrens Hosp, Div Cardiol, St Louis, MO 63110 USA
[2] Cleveland Clin Fdn, Dept Pediat Cardiol, Cleveland, OH 44195 USA
[3] Columbia Univ, New York Presbyterian Hosp, Div Pediat Cardiol, New York, NY USA
[4] Univ Utah, Primary Childrens Med Ctr, Div Pediat Cardiol, Salt Lake City, UT USA
[5] Northwestern Univ, Childrens Mem Hosp, Div Cardiol, Chicago, IL 60614 USA
[6] Harvard Univ, Sch Med, Childrens Hosp, Dept Cardiol, Boston, MA USA
关键词
D O I
10.1067/mpd.2001.113045
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective: The objective was to determine the dosing, efficacy, and side effects of the nonselective beta -blocker carvedilol for the management of heart failure in children. Study design: Carvedilol use in addition to standard medical therapy for pediatric heart failure was reviewed at 6 centers. Results: Children with dilated cardiomyopathy (80%) and congenital heart disease (20%), age 3 months to 19 years (n = 46), were treated with carvedilol. The average initial dose was 0.08 mg/kg, uptitrated over a mean of 11.3 weeks to an average maintenance dose of 0.46 mg/kg. After 3 months on carvedilol, there were improvements in modified New York Heart Association class in 67% of patients (P = .0005, chi (2) analysis) and improvement in mean shortening fraction from 16.2% to 19.0% (P = .005, paired t test). Side effects, mainly dizziness, hypotension, and headache, occurred in 54% of patients but, were well tolerated. Adverse outcomes (death, cardiac transplantation, and ventricular-assist device placement) occurred in 30% of patients. Conclusions: Carvedilol as an adjunct to standard therapy for pediatric heart failure improves symptoms and left ventricular function. Side effects are common but well tolerated. Further prospective study is required to determine the effect of carvedilol on survival and to clearly define its role in pediatric heart failure therapy.
引用
收藏
页码:505 / 511
页数:7
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