the effect of carvedilol treatment on chronic heart

The Effect of Carvedilol Treatment on Chronic Heart Failure in Pediatric

Patients with Dilated Cardiomyopathy : A Prospective, randomized-

controlled study

Dian Puspita

Pediatric Cardiology DivisionDepartment of Cardiology and Cardiovascular Medicine

Faculty of Medicine Andalas UniversityM.Djamil Hospital Padang

Introduction

DCM

chronic heart

failure

• reported incidence of 3.3-7.3 per million

• 71–79 % DCM chronic heart failure

The use of beta-adrenergic

blocking agents

(Carvedilol)for the

treatment of heart failure

• experience with the drug in

pediatric patients is limited

• its effectiveness and safety

remain to be confirmed.

Subjects

January

2008 -

December

2010, 112

pts DCM.

89 pts met

criteria &

participate

d in the

trial.

12 pat

lost 77

patients in

the final

analyses.

carvedilol-

treated

group

Methods

control group

Inclusion and Exclusion Criteria

Inclusion

Age:1 month to 18 yo

Chronic heart failure

grade 2 or 3 heart

function (Ross criteria)

at least 1 month of

conventional treatment

LVEF less than 45 %

Exclusion

secondary DCMgrade 1 heart function or other unstable

conditionsevere atrioventricular regurgitation or

ventricular outflow obstructionsevere ECG abnormalities

Low systolic blood pressure

a low resting heart rate

renal or hepatic insufficiency

oversensitivity to beta-blockers.

control group

carvedilolgroup

studyTrial

initial dose 0.1 (mg/kg day)

doubled every 2 weeks until the highest tolerated dose (< 0,8

mg/kgday)

not increased in infection, low HR, 50%

improvement in heart fx and LVEF

After discharge, the patients were followed regularly by cardiologists.

ameliorated

Unchanged

Deteriorated

Statistical Analysis

All data are presented as means ± standard deviations.

using the Statistical Package for the Social Sciences, version 16.0 (SPSS, Chicago, IL,

USA) and included t tests for comparisons of measured data between groups and the

Chi square test for

between-group comparisons of enumerated data.

A P value lower than 0.05 was considered statistically

significant.

Results

Heart Function

decreases in Ross scores- 11.94 % for the

experimental group

- 2.81 % for thecontrol group

EchocardiographyBrain Natriuretic

Peptide

Clinical Resultsimprovement- 40 %experimental- 35.2 % control

deterioration- 25 %experimental- 37.8 % control

Drug Safety

Discussion

Chronic Heart Failure

myocardial cell damage

ventricular remodeling

sympathetic nervous system

RAAsystem

beta-blockers

Three types of

beta-blockers

carvedilol

a1,b1, and b2

receptorsnitric oxide antioxidants

bisoprolol metoprolol

Last Studies

Shaddy in 1998

Blume et al

Li et al

Matiteu et al

Limitation

number of cases in this report is small

the drug’s effective dose requires additional exploration

significant clinical efficacy usually appears after 2–3 months of beta-blocker therapy

in adult patients

the etiology of cardiomyopathy in pediatric patients is significantly different from that in

adult patients,

improvements in cardiac function, as indicated by Ross scores, echocardiography,

and decreased serum BNP levels

Hepatic and renal function abnormalities did not occur in any patients during the

treatment regimen

carvedilol is relatively safe for use in pediatric populations.

13

1. THE TITLE:

INTERESTING OR

USEFUL ?

YES

How efficacy and safety in using carvedilol for the

treatment Chronic Heart Failure in Pediatrics

Patient with dilated cardiomyopathy

2. THE AUTHORS:

GOOD TRACK

RECORD ?

DIRECTLY

DON’T

KNOW

THE ARTICLE WAS TAKEN FROM FAMOUS

INTERNATIONAL PUBLISHED JOURNAL

BUT

3. THE SUMMARY:

IF VALID, WOULD

THESE

RESULTS BE

USEFUL ?

The study showed that an improvement in the cardiac

function of the patients who treat with carvedilol and

carvedilol is relatively safe for use in pediatric pts.

YES

4. CONSIDER THE

SITE:

IF VALID, WOULD

THESE

RESULTS APPLY IN

YOUR

PRACTICE ?

YES

Some of the results of this study can apply in our

practice

18

5. READ THE

PATIENTS

AND

METHODS

SECTIONStep Two:

Deciding whether the basic methods used

were strong or weak ?

19

22

Pathophysiology Of The Heart Disease, Lily

Pathophysiology Of The Heart Disease, Lily

British Hypertension Society

Moss and Adams Heart Disease in Infants, Children, and adolescent,

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14

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