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Left ventricular reverse remodeling with infantile dilated cardiomyopathy and pitfalls of carvedilol therapy

Etsuko Tsuda1, Jun Negishi1, Kanae Noritake1

  • 1Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan.

Journal of Cardiology
|November 18, 2015
PubMed

Insights

Idiopathic dilated cardiomyopathy (DCM) in infants may worsen with standard carvedilol doses. Careful titration of low-dose carvedilol, guided by BNP levels, is crucial for improving left ventricular reverse remodeling (LVRR) and heart failure outcomes.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Research
  • Pharmacology

Background:

  • Idiopathic dilated cardiomyopathy (DCM) and its impact on infant heart function are not fully understood.
  • Left ventricular reverse remodeling (LVRR) and carvedilol treatment efficacy in severe infantile heart failure require further investigation.

Purpose of the Study:

  • To investigate LVRR in infants with DCM.
  • To evaluate the role of carvedilol treatment in severe infantile heart failure due to DCM.

Main Methods:

  • Retrospective review of medical records for 5 infants (around 12 months old) with severe heart failure from DCM.
  • Defined LVRR by increased left ventricular fractional shortening (LVFS) >10% and percent of normal left ventricular end-diastolic dimension (%LVDd) <120%.

Main Results:

  • Four out of five infants relapsed with worsening heart failure despite standard carvedilol doses.
  • Brain natriuretic peptide (BNP) levels decreased upon carvedilol dose reduction.
  • Over 24 months, significant improvements in LVFS (11±2% to 34±5%) and %LVDd (149±27% to 108±11%) were observed.

Conclusions:

  • LVRR was observed two years post-DCM onset in infants.
  • Standard carvedilol induction doses may exacerbate heart failure in some infants.
  • Close monitoring and slow, low-dose carvedilol titration guided by BNP levels are essential for managing infantile DCM.
Abstract

Keywords:
Brain natriuretic peptideCarvedilolDilated cardiomyopathyHeart failureLeft ventricular reverse remodeling

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