Beta-blocker treatment of dilated cardiomyopathy with congestive heart failure in children: a multi-institutional experience

Abstract

Background Dilated cardiomyopathy is the primary indication for heart transplantation in children beyond infancy. Although beta-blockers improve symptoms, ejection fraction, and survival in adults with congestive heart failure, little is known of their effects in children. Methods This study reviews our pediatric experience with the beta-blocker, metoprolol, at 3 institutions. We gave metoprolol to 15 children, age 8.6 ± 1.3 years (range 2.5 to 15 years), with idiopathic dilated cardiomyopathy (n = 9), anthracycline cardiomyopathy (n = 3), and Duchenne muscular dystrophy cardiomyopathy, post-myocarditis cardiomyopathy, and post-surgical cardiomyopathy (n = 1 each). All had been treated with conventional medications (digoxin, diuretics, and ACE inhibitors) for 22.5 ± 9 months before starting metoprolol. Metoprolol was started at 0.1 to 0.2 mg/kg/dose given twice daily and slowly increased over a period of weeks to a dose of 1.1 ± 0.1 mg/kg/day (range 0.5 to 2.3 mg/kg/day). Results Between the time point of stabilization on conventional medications and the initiation of metoprolol therapy, there was no significant change in fractional shortening (13.1 ± 1.2% vs 15.0 ± 1.2%) or ejection fraction (25.6 ± 2.1% vs 27.0 ± 3.4%). However, after metoprolol therapy for 23.2 ± 7 months, there was a significant increase in fractional shortening(23.3 ± 2.6%) and ejection fraction (41.1 ± 4.3%) ( p < 0.05). Conclusions Metoprolol improves ventricular function in some children with dilated cardiomyopathy and congestive heart failure. Further study is warranted to better define which children may benefit most from beta-blocker therapy and which beta-blockers are most efficacious.