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Medical treatment in pediatric patient with dilated cardiomyopathy (DCM) is not as well standardized as in the adult population in relation to medications and dosages; use of carvedilol remains controversial. We reviewed our experience over the past 14 years in treating children with DCM.
We reviewed demographic, diagnosis, dosage of medications and echocardiograms measurements of ejection fraction (EF), fractional shortening corrected by age (FSz) and left ventricular end diastolic diameter corrected by BSA (LVEDDz) to assess outcome and response to treatment.
We identified 108 children,(58 male) age at presentation 7.4[[Unsupported Character – Codename ]]±6.5 years with a diagnosed of DCM; mean EF and FSz at presentation was 28.9±10 and −8.1±6.7. Combination of carvedilol and ACE inhibitor was used in 72% of the patients. Average dose in mg/kg/day of carvedilol was 0.95 (range 0.05 to 1.7), enalapril 0.64 (0.08 to 1.2) and captopril 3.4 (0.45 to 6.4). Average follow up was 6.2±5.5 years. Death or transplant occurred in 45% of children in 40% of them death/Transplant occurred within 1 year from presentation. In the survivors EF and FSz improved from 29.3±9.6 to 53.8±9 (p<0.001) and −8.3±7.4 to −3.1±3.5 (p=0.002); in 80% of the survivor EF improved to >50%. LVEDDz decreased from 4.5±2.9 to 1.7±2.1 (p<0.001). Only 3 patients did not tolerate carvedilol 2 because of asthma and 1 for worsening heart failure; 3 patients experienced one episode of hypoglycemia.
Mortality and transplant remain elevated in children with DCM particularly in the first year of presentation. Carvedilol and ACE inhibitors are well tolerated at the dose used and appear to be safe when used long term. Efficacy remains to be demonstrated.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Heart Failure: Pharmacologic Therapy
Abstract Category: 17. Heart Failure: Therapy
Presentation Number: 1223-312
- 2013 American College of Cardiology Foundation