title: Effects of beta-blockers for congestive heart failure in pediatric and congenital heart disease patients: a meta-analysis of published studies.
abstract: OBJECTIVE
  The effects of beta-blockers in pediatric and congenital heart disease (CHD) patients suffering from heart failure are controversial. We performed a meta-analysis to determine whether beta-blockers are effective for heart failure in pediatric and CHD patients.
  
  
  METHODS
  We searched for clinical trials focusing on clinical on clinical and ventricular functional/dimensional changes after beta-blocker therapy in PubMed (from its inception to August 2013) and bibliographies of identified studies. Studies investigating any of three beta blockers (carvedilol, bisoprolol, and extended release metoprolol succinate) which are known to be effective in adult patients with heart failure were included.
  
  
  RESULTS
  Of the 158 screened, 17 (N.=476) fulfilled the study criteria and were analyzed. Beta-blockers were associated with significant improvements in left ventricular (LV) ejection fraction (EF) (12.47%; 95% CI, 10.36 to 14.61), fraction shortening (5.75%; 95% CI, 4.42 to 7.08), LV end-diastolic dimension (-2.91 mm; 95% CI, -5.46 to -0.36), and LV systolic dimension (-4.03 mm; 95% CI, -6.81 to -1.25). No significant change in the pooled mean difference of the right ventricular (RV) EF (3.50%; P=0.08) was observed. However, the RV EF in the untreated group showed a deteriorating trend (-3%), which was different from the trend in the treatment group. There was a significant reduction in the incidence of clinical worsening (odds ratio, 2.15; 95% CI, 1.27 to 3.66).
  
  
  CONCLUSIONS
  Beta-blocker therapy was associated with a significant improvement of echocardiographic parameters in patients with systemic LV failure. However, the use of beta-blockers did not provide significant benefits in terms of improving the EF in patients with RV failure. Nonetheless, beta-blockers may be effective to prevent the clinical deterioration of pediatric and CHD patients with heart failure.
authors.affiliation: Pediatrics, Medical Research Institute of Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea - mjchomd@gmail.com.
authors.forename: M J
authors.initials: MJ
authors.lastname: Cho
authors.forename: R K
authors.initials: RK
authors.lastname: Lim
authors.forename: M
authors.initials: M
authors.lastname: Jung Kwak
authors.forename: K H
authors.initials: KH
authors.lastname: Park
authors.forename: H Y
authors.initials: HY
authors.lastname: Kim
authors.forename: Y M
authors.initials: YM
authors.lastname: Kim
authors.forename: H D
authors.initials: HD
authors.lastname: Lee
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000367:Age Factors; D017298:Bisoprolol / Q000627:therapeutic use; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D002648:Child; D006330:Heart Defects, Congenital / Q000188:drug therapy* / Q000503:physiopathology; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008790:Metoprolol / Q000627:therapeutic use; D011412:Propanolamines / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol; D017298:Bisoprolol