Pediatric heart failure therapy: why β1-receptor blocker, tissue ACE-I and mineralocorticoid-receptor-blocker?

Area of Science:

• Pediatric Cardiology
• Pharmacology
• Cardiovascular Medicine

Background:

• Pediatric heart failure (HF) treatment historically lags behind adult advancements.
• Limited prospective, double-blind randomized studies exist for pediatric HF pharmacotherapy.
• Current pediatric HF management often relies on extrapolations from adult data.

Purpose of the Study:

• To review and recommend specific pharmacotherapies for pediatric heart failure.
• To guide the preferred indication of beta-1 adrenergic receptor blockers (ARB), mineralocorticoid antagonists, and angiotensin-converting enzyme inhibitors (ACE-I) in children.
• To bridge the gap between evidence-based and pathophysiology-based approaches in pediatric HF.

Main Methods:

• Review of pharmacological research, clinical experience, and receptor-physiological knowledge in pediatric HF.
• Analysis of drug specificity, effectiveness, and side-effect profiles in children.
• Consideration of negative results from limited pediatric HF studies.

Main Results:

• Bisoprolol, lisinopril, and spironolactone (BLS) are recommended for specific pediatric HF populations, including those with left-right shunt lesions and reduced ejection fraction.
• Avoidance of chronic diuretic use and fluid restriction is advised to prevent neurohumoral axis overstimulation.
• Personalized treatment strategies are supported by surrogate parameters like heart rate, breath pattern, weight gain, and biomarkers.

Conclusions:

• Effective pediatric HF treatment requires a strategy that respects unique pathophysiology and receptor physiology in children.
• Personalized pharmacotherapy, such as the BLS regimen, can improve outcomes in pediatric HF patients.
• Optimized HF therapy is crucial for novel regenerative strategies and avoiding cardiac transplant in pediatric patients.