Propranolol treatment of congestive heart failure in infants with congenital heart disease: The CHF-PRO-INFANT Trial. Congestive heart failure in infants treated with propanol.
OBJECTIVE
Infants with congenital heart disease and left-to-right shunts may develop significant clinical symptoms of congestive heart failure in spite of therapy with digoxin and diuretics. We investigated the effects of beta-blockade in infants with severe heart failure.


RESULTS
We performed a prospective, randomized, open monocenter trial in infants treated with digoxin and diuretics (n=10) in comparison to 10 infants receiving additional beta-blocker therapy. After 17 days on average beta-blocker treated infants (propranolol:1,6 mg/kg/day) improved significantly with respect to Ross heart failure score (3.3+/-2.3 vs. 8.3+/-1.9, P=0.002), lower renin levels (338+/-236 vs. 704+/-490 microU/l, P=0.008) and lower mean heart rates in Holter ECG (118+/-10 vs. 142+/-11 beats/min, P<0.001). While digoxin and diuretic treated infants had unchanged mean heart rate (149+/-8 vs. 148+/-10 beats/min), less decrease of symptoms (Ross Score: 8.5+/-1.7 vs. 6.8+/-2.3, P=0.02) but a significant increase of renin levels (139+/-102 vs. 938+/-607 microU/l, P=0.001).


CONCLUSIONS
Additional propranolol treatment but not digoxin and diuretics alone can effectively reduce clinical symptoms of heart failure in infants with congenital heart disease, who suffer from increased neurohormonal activation.
Buchhorn
R
R
Abteilung Pädiatrische Kardiologie, Georg-August-Universität Göttingen, Robert-Koch Str. 40, D-37075 Göttingen, Germany. rbuchho@gwdg.de
Hulpke-Wette
M
M
Hilgers
R
R
Bartmus
D
D
Wessel
A
A
Bürsch
J
J
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D006330:Heart Defects, Congenital / Q000150:complications*; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology; D006339:Heart Rate / Q000187:drug effects; D006343:Heart Septal Defects / Q000150:complications*; D006439:Hemodynamics / Q000187:drug effects; D006728:Hormones / Q000097:blood; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011433:Propranolol / Q000627:therapeutic use*; D011446:Prospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D004232:Diuretics; D006728:Hormones; D004077:Digoxin; D011433:Propranolol