Abstract
Our first intention to treat infants’ heart failure with beta blockers was to improve the clinical condition as shown in our prospective randomized trial. We only use non-selective beta blockers in these infants, carvedilol in those with left ventricular dysfunction and propranolol in those with congenital heart disease without ventricular dysfunction. Despite a significant improvement of Ross’s heart failure score, we could not convince most colleagues within the last 25 years if the concept of neurohumoral activation in heart failure is not well-established pediatric cardiology. Recently, Honghai Liu et al. published that cardiomyocyte cytokinesis failure was increased in congenital heart disease. Inactivation of the beta adreno receptors genes and administration of the beta-blocker propranolol increased cardiomyocyte division in neonatal mice, which increased the number of cardiomyocytes (endowment) and conferred benefit after myocardial infarction in adults. We currently realize that propranolol in infants with congenital heart disease not only decrease highly elevated NT-Pro-BNP values but also decrease cardiac troponin T values that may indicate myocardial injury due to neurohumoral activation. We reproduce this observation, primarily seen in infants with congenital heart disease, in an infant with Duchenne muscular dystrophy. These observations were in good accordance with current data from H. Liu et al., who showed that treatment with non-selective beta blockers early after birth might rescue cytokinesis defects and prevent heart dysfunction in adulthood in a mouse model.
Highlights
Based upon 25 years’ experience with beta blocker treatment in infants with heart failure due to congenital disease, I will discuss three clinical cases that show that myocardial protection in early infancy with propranolol and carvedilol treatment may prevent myocardial injury in infants with heart failure due to congenital heart disease or Duchenne muscular dystrophy
CTnT has been investigated as a prognostic marker and is a strong and independent predictor of all-cause and cardiovascular mortality, and of hospitalization for cardiovascular causes in patients with chronic heart failure [5]
Two recently published studies confirm the prognostic value of elevated cardiac troponin T (cTnT) level in children with congenital heart disease [6] [7]
Summary
Liu et al showed that treatment with non-selective beta blockers early after birth might rescue cytokinesis defects in infants with congenital heart defects and prevent heart dysfunction in adulthood in a mouse model [1]. There are currently no guidelines for the use of beta blockers, such as propranolol, to treat heart failure in infants with congenital heart disease despite significant supporting evidence for the clinical use [2]. Based upon 25 years’ experience with beta blocker treatment in infants with heart failure due to congenital disease, I will discuss three clinical cases that show that myocardial protection in early infancy with propranolol and carvedilol treatment may prevent myocardial injury in infants with heart failure due to congenital heart disease or Duchenne muscular dystrophy
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have