The impact of the carvedilol therapy on the chronic heart failure in children. Does it depend on the morphological deference of systemic ventricle?

Abstract

Background: There have been a few reports about the use of carvedilol in children with congenital heart disease (CHD) to treat chronic heart failure. Purpose: To examine the effectiveness of carvedilol for children with chronic heart failure including congenital heart disease.[Subjects]32 patients admitted for heart failure were initiated carvedilol from January 1999 to December 2012. They consisted of 16 males and 16 females, with ages ranging from 1.8 years to 21.6 years (mediam age:5.3±6.0 years). Fourteen patients had congenital heart disease (hypoplastic heart syndrome in 7 and other CHDs in 7). Heart failure occurred due to myocardial infarction in 6, cardiomyopathy in 7 and myocarditis in 5. The mean age when they were initiated carvedilol administration was 1.1±3.7 years (range:1 months to 13 years).The mean follow-up period was 3.3±3.6 years (range:1.1 years to 13.5 years). Methods: To evaluate the efficacy of carvedilol therapy quantitatively, we use these parameters: cardiothoracic ratio (CTR), b-type natriuretic peptide (BNP), fractional area change (FAC), Tei index,of systolic ventricle, and the early diastolic velocity at the mitral annulus (e'). We devided the patients into two groups. In group A, The patients have systemic ventricule, while in group B, the patients have systemic ventricle. We compared the parameters between two groups before initiation of carvedilol and at the end of the flollow-up period. Moreover, we compared the difference of the change of these parameters in each group.[Results]In both groups,CTR,BNP and Tei index were decreased significantly (CTR:A 55±5% vs. 50±5%,p<0.01, B 59±6% vs. 51±6%,p<0.001; mean BNP:A 251±335pg/ml vs. 26±24pg/ml p<0.01,B 286±781pg/ml vs. 26±153pg/ml p<0.01, Tei:A 0.65±0.13 vs. 0.44±0.11 p<0.01,B 0.59±0.15 vs. 0.31±0.10 p<0.001). FAC is also improved significantly in both groups (A 0.27±0.07 vs. 0.34±0.05, p<0.01,B 0.21±0.08 vs. 0.36±0.07, p<0.001). But e' is not changed significantly during this period (A 6.0±4.2cm/s vs. 7.2±2.3cm/s, B 5.9±2.9cm/s vs. 11.0±3.9cm/s). Then, there was no significant difference in the change of each parameters between two groups. Conclusions: Carvedilol therapy for chronic heart failure in children is effective in the patients with CHD. The efficacy does not depend on the morphological difference of the systemic ventricule, right or left