Echocardiographic evaluation of children with systemic ventricular dysfunction treated with carvedilol.
Echocardiography is used to measure the therapeutic effectiveness of heart failure therapy in adults and children. The purposes of this study were (1) to assess baseline echocardiographic predictors of clinical outcome, (2) to investigate changes in echocardiographic parameters, and (3) to compare these echocardiographic changes with changes in plasma levels of b-type natriuretic peptide (BNP) in a population of children with systemic ventricular dysfunction and symptomatic heart failure treated with carvedilol or placebo. All available baseline and 6-month echocardiograms from Pediatric Carvedilol Trial (PCT) participants (carvedilol n = 161; placebo n = 55) were reviewed. Systolic and diastolic sphericity index (SI; n = 110), TEI index (n = 145), and systemic ventricular dP/dt (n = 70) were measured. The PCT composite definition of clinical outcome (i.e., worsened, improved, or unchanged) was used. For all patients, baseline TEI index was a predictor of worsened outcome. Only children treated with carvedilol showed a significant decrease in systolic SI (P B 0.0001), diastolic SI (P B 0.0001), and TEI index (P = 0.02). An inverse correlation between changes in BNP and changes in dP/dt (r = -0.45, P = 0.04) was found only in the carvedilol group. In conclusion, TEI index predicted outcome in children with systemic ventricular dysfunction and heart failure. Carvedilol may have a beneficial effect on reversal of left ventricular remodeling and global ventricular function in pediatric heart failure.
Petko
Colin
C
Division of Pediatric Cardiology, Universitätsklinikum Schleswig-Holstein, 24105 Kiel, Germany. petko@pedcard.uni-kiel.de
Minich
L LuAnn
LL
Everitt
Melanie D
MD
Holubkov
Richard
R
Shaddy
Robert E
RE
Tani
Lloyd Y
LY
D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D002227:Carbazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D000077261:Carvedilol; D002675:Child, Preschool; D003971:Diastole; D004305:Dose-Response Relationship, Drug; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009200:Myocardial Contraction / Q000187:drug effects* / Q000502:physiology; D011412:Propanolamines / Q000008:administration & dosage / Q000627:therapeutic use*; D013599:Systole; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology
D000317:Adrenergic alpha-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol
J Cardiol. 1995 Aug;26(2):135-6
7674144
Am Heart J. 1999 Apr;137(4 Pt 1):646-52
10097224
J Am Soc Echocardiogr. 1992 Mar-Apr;5(2):147-52
1571168
Can J Cardiol. 2005 Mar 15;21(4):344-8
15838561
N Engl J Med. 1996 May 23;334(21):1349-55
8614419
Eur J Heart Fail. 2009 Jan;11(1):48-52
19147456
Am J Cardiol. 1998 Nov 1;82(9):1071-6
9817484
BMJ. 2005 Mar 19;330(7492):625
15774989
Congest Heart Fail. 2004 Sep-Oct;10(5 Suppl 3):1-30
15604859
JAMA. 2007 Sep 12;298(10):1171-9
17848651
Heart. 2004 Aug;90(8):908-15
15253966
J Am Soc Echocardiogr. 2002 Sep;15(9):864-8
12221401
Am J Cardiol. 2005 Oct 15;96(8):1157-61
16214456
Circulation. 2002 Oct 22;106(17):2194-9
12390947
J Am Soc Echocardiogr. 1998 Sep;11(9):849-56
9758376
J Am Coll Cardiol. 2000 Nov 1;36(5):1594-9
11079663
Am J Cardiol. 1999 Apr 15;83(8):1201-5
10215284