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Left ventricular reverse remodeling with infantile dilated cardiomyopathy and pitfalls of carvedilol therapy.
- Source :
-
Journal of cardiology [J Cardiol] 2016 Feb; Vol. 67 (2), pp. 147-52. Date of Electronic Publication: 2015 Nov 10. - Publication Year :
- 2016
-
Abstract
- Background: The left ventricular reverse remodeling (LVRR) in idiopathic dilated cardiomyopathy (DCM) and the treatment with carvedilol in infants with severe heart failure remain poorly understood.<br />Methods: We reviewed the medical records of 5 infants around 12 months old referred to our hospital with severe heart failure due to DCM. Increased left ventricular fractional shortening (LVFS) by more than 10% and the percent of normal of left ventricular end-diastolic dimension (%LVDd) less than 120% were defined as LVRR in this study.<br />Results: DCM onset ranged from 8 to 16 months. Initial treatment of their acute heart failure was successful in all 5 but 4 patients relapsed despite the usual dose of carvedilol (induction 0.02-maintenance 0.4mg/kg/day), and developed worsening heart failure. Brain natriuretic peptide (BNP) levels which increased again after the acute treatment had fallen subsequent to discontinuing or decreasing carvedilol. Over 24 months, LVFS had increased from 11±2% (mean±SD) to 34±5% (p<0.05), and %LVDd decreased from 149±27% to 108±11% (p<0.05).<br />Conclusions: LVRR was found at 2 years after the onset of DCM. Usual dose induction of carvedilol therapy can sometimes worsen heart failure after successful initial conventional treatment for the acute heart failure in DCM. Close control of carvedilol treatment may determine the prognosis of infantile DCM around 12 months old. It is prudent to increase low-dose carvedilol slowly corresponding with the BNP level.<br /> (Copyright © 2015. Published by Elsevier Ltd.)
- Subjects :
- Cardiomyopathy, Dilated blood
Cardiomyopathy, Dilated complications
Carvedilol
Dose-Response Relationship, Drug
Female
Heart Failure etiology
Humans
Infant
Male
Natriuretic Peptide, Brain blood
Prognosis
Retrospective Studies
Time Factors
Adrenergic beta-Antagonists administration & dosage
Carbazoles administration & dosage
Cardiomyopathy, Dilated drug therapy
Heart Failure drug therapy
Propanolamines administration & dosage
Ventricular Remodeling drug effects
Subjects
Details
- Language :
- English
- ISSN :
- 1876-4738
- Volume :
- 67
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 26572957
- Full Text :
- https://doi.org/10.1016/j.jjcc.2015.08.022