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[Preliminary study on the effect of carvedilol on children with primary endocardial fibroelastosis]
Rong Li1, Qi-jian Yi, Yong-ru Qian
1Department of Cardiovascular Medicine, Children's Hospital, Chongqing Medical University, Chongqing 400014, China.
Insights
Carvedilol effectively treats pediatric endocardial fibroelastosis (EFE) by reducing brain-type natriuretic peptide (BNP) levels and improving cardiac function. This study confirms carvedilol
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Pharmacology
Background:
- Endocardial fibroelastosis (EFE) is a significant pediatric cardiovascular disease often leading to chronic heart failure (CHF).
- Current treatments for CHF in EFE patients involve beta-adrenoreceptor blockers combined with traditional medications.
- This approach has shown potential in improving left ventricular function and preventing adverse cardiac remodeling.
Purpose of the Study:
- To evaluate the efficacy of carvedilol in reducing plasma brain-type natriuretic peptide (BNP) concentrations in children with EFE.
- To assess the safety and impact of carvedilol on cardiac function and clinical symptoms in pediatric EFE patients.
Main Methods:
- A randomized study involving 21 children with EFE, divided into two groups: traditional regimen (n=10) and carvedilol plus traditional regimen (n=11).
- Plasma BNP levels were measured using ELISA, and cardiac function was assessed via ultrasound before and after 6 months of treatment.
- Observed outcomes included changes in clinical symptoms, heart rate, cardiac function, and side effects.
Main Results:
- Children with EFE exhibited significantly higher plasma BNP levels compared to controls, correlating positively with cardiac dysfunction severity.
- Carvedilol treatment led to a significant decrease in plasma BNP levels and notable improvements in clinical symptoms.
- Significant enhancements in ejection fraction, fractional shortening, and mean velocity of circumferential fiber shortening were observed, alongside reductions in cardio-thoracic ratio, heart rate, and ventricular dimensions.
Conclusions:
- Plasma BNP levels are elevated in pediatric EFE and are effectively reduced by carvedilol.
- Carvedilol demonstrates efficacy in inhibiting ventricular remodeling and improving cardiac function in children with EFE.
- The study concludes that carvedilol is a safe and effective therapeutic option for treating children diagnosed with EFE.
Objective:
Endocardial fibroelastosis (EFE), a common pediatric cardiovascular disease, often results in chronic heart failure (CHF) and death. Clinical trials have shown that the regimen of combining beta-adrenoreceptor blocker with traditional medicines against CHF can improve left ventricular function and prevent the ventricle from remodeling in patients with CHF. The present study aimed to observe the effect of carvedilol on concentration of plasma brain-type natriuretic peptide (BNP), and safety in children with EFE.
Methods:
Twenty-one children with EFE were randomly divided into two groups: (1) treated with traditional regimen (digoxin, prednisone and/or diuretics) (n = 10); (2) treated with carvedilol plus traditional regimen (n = 11). Measurement of plasma concentration of BNP by ELISA, cardiac function by ultrasound were performed before and after 6 months of treatment. The changes in clinical symptom, heart rate, heart function, side effect and maximal tolerance dose after treatment with carvedilol were observed.
Results:
Plasma concentration of BNP was much higher in the group of patients with EFE [(865 +/- 702) ng/L] than that of control group [(154 +/- 78) ng/L] (P < 0.01), and there was a positive correlation between plasma concentration of BNP and cardiac function classification, and cardiac function grades II, III, and IV corresponded to plasma concentration of BNP (286 +/- 125) ng/L, (437 +/- 386) ng/L, (1673 +/- 859) ng/L respectively in children with EFE. Compared with the group treated with traditional medicines, plasma concentration of BNP [(403 +/- 216) ng/L vs. (219 +/- 87) ng/L] significantly decreased, the clinical symptom was significantly improved, cardio-thoracic ratio (CTR) (0.60 +/- 0.05 vs. 0.54 +/- 0.06) (P < 0.05) and heart rate [(115 +/- 20) bpm vs. (90 +/- 14) bpm] (P < 0.01) decreased, ejection fraction (EF) (46.6% +/- 13.4% vs. 54.5% +/- 12.9%), fractional shortening (21.6% +/- 8.1% vs. 24.1% +/- 7.5%), mean velocity of circumferential fiber shortening [(0.8 +/- 0.5) cir/s vs. (0.9 +/- 0.4) cir/s] were significantly increased (P < 0.01), left ventricular end-systolic dimension [(34.0 +/- 8.6) mm vs. (32.2 +/- 9.1) mm] (P < 0.05), left ventricular mass [(65.9 +/- 34.1) g vs. (65.9 +/- 34.1) g], interventricular septal thickness at end-systole [(6.0 +/- 1.0) mm vs (5.5 +/- 1.1) mm] were notably decreased (P < 0.01) after treatment with carvedilol.
Conclusion:
These data indicated that plasma concentration of BNP significantly increased in children with EFE, carvedilol can decrease plasma concentration of BNP, inhibit the remodeling of ventricle, significantly improve the cardiac function in children with EFE. Carvedilol is effective and safe in treatment of children with EFE.
