Author + information
- Ivan Wilmot,
- Marco Rodriguez,
- Kriti Puri,
- Juan Feng,
- BreAnn Taylor,
- Jacob Mathew,
- Thomas Ryan and
- John Jefferies
Background: Individuals living with dilated cardiomyopathy (DCM) are at risk of significant heart failure (HF) related morbidity and mortality. Contemporary adult HF guidelines recommend using HF medications [Beta-Blockers (BBs), Angiotensin Converting Enzyme inhibitors (ACEis)] in individuals with DCM and HF. These have been associated with improved left ventricular ejection fraction (LVEF), left ventricular end diastolic dimension (LVEDD), heart rate, and survival in this population. Pediatric patients with DCM and HF have been reported to have a poor prognosis with considerable mortality in the past. However, the response to these HF medications in the pediatric DCM population has not been extensively studied.
Methods: We retrospectively reviewed pediatric patients with DCM, defined as LVEDD > 2 Z-scores, and left ventricular dysfunction, defined as LVEF < 55%, treated at our center. We evaluated the effect of individual or combination therapy of BB and/or ACEi on serial measurements of LVEF, LVEDD, average heart rate, and mortality. Continuous data was assessed by Student t tests or Mann-Whitney U test, and categorical data was assessed by chi-square test.
Results: A total of 66 individuals were identified between April 1995 and June 2014. The mean age was 11.6 ± 9.4 yrs. with a follow up of 5.0 ± 5.0 years. Diagnosis with a dilated phenotype included idiopathic DCM (n=40), left ventricular non-compaction (LVNC) (n=24), Alstrom's syndrome (n=1), and Takayasu arteritis (n=1). Over the course of the study period there was a significant increase in mean LVEF (7.2 ± 14.5 %, p<0.01), decrease in LVEDD Z-score (1.0 ± 1.6, p<0.01), and decrease in heart rate (15.6 ± 30.2, p<0.01). Only 1 individual died during the study period.
Conclusions: The use of HF medications in pediatric patients with DCM is associated with a significant improvement in LVEF, decrease in LVEDD, decrease in heart rate, and low overall mortality. These findings are promising and suggest occurrence of reverse remodeling in our population.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Making Progress in Understanding Heart Failure
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1123-292
- 2017 American College of Cardiology Foundation