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Real-World Use of Carvedilol in Children With Dilated Cardiomyopathy: Long-Term Effect on Survival and Ventricular

Rachele Adorisio1, Nicoletta Cantarutti2, Marco Ciabattini3

  • 1Advanced Cardiovascular Therapies, Department of Cardiology, Cardiac Surgery, Heart and Lung Transplant, Bambino Gesù Children Hospital and Research Institute, Rome, Italy.

Frontiers in Pediatrics
|April 18, 2022
PubMed

Insights

High-dose carvedilol significantly improves heart function and survival in children with chronic heart failure (HF). This study demonstrates improved ventricular function and reduced mortality in pediatric patients receiving higher carvedilol dosages.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Research
  • Pharmacology

Background:

  • Carvedilol is recommended for pediatric chronic heart failure (HF).
  • Optimal dosing and long-term effects of carvedilol in children remain unclear.
  • Lack of standardized protocols necessitates further investigation into effective treatment strategies.

Purpose of the Study:

  • To evaluate the impact of a high-dosage carvedilol regimen on cardiac outcomes in pediatric patients with HF.
  • To assess the efficacy of intensified carvedilol therapy in improving ventricular function and survival rates.
  • To provide evidence-based recommendations for carvedilol use in children with dilated cardiomyopathy and chronic HF.

Main Methods:

  • Retrospective cohort study design including children with HF and dilated cardiomyopathy.
  • Analysis of medical records at baseline, 1 year, and 3 years post-maximum carvedilol dosage, compared to a historical control group.
  • Kaplan-Meier analysis and Cox proportional hazard regression to assess outcomes, with mortality and heart transplant as primary endpoints.

Main Results:

  • Sixty-five children received high-dosage carvedilol (up to 1 mg/kg/day), showing significant heart rate reduction (30%) and ejection fraction improvement (32% to 45%).
  • Statistically significant improvements in long-term survival and freedom from heart transplant were observed in the high-dosage carvedilol group (p=0.00001).
  • The study included 135 children, with 65 in the high-dosage carvedilol treatment arm.

Conclusions:

  • High-dosage carvedilol, as an adjunct to standard HF therapy, significantly enhances ventricular function in children.
  • This intensified treatment regimen demonstrably improves long-term survival rates in pediatric patients with dilated cardiomyopathy and chronic HF.
  • The findings support the use of higher carvedilol doses for improved outcomes in pediatric heart failure management.
Abstract

Keywords:
carvedilolchildrendilated cardiomyopathyheart failureβ-blockers

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