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Hypertrophic cardiomyopathy during corticotropin therapy for infantile spasms. A clinical and echocardiographic study
G B Bobele1, K E Ward, J B Bodensteiner
1Department of Neurology, University of Oklahoma Health Science Center, Oklahoma City 73126.
Insights
Corticotropin treatment for infantile spasms frequently causes abnormal cardiac hypertrophy, including hypertrophic cardiomyopathy. These cardiac changes were reversible and did not necessitate stopping treatment.
Area of Science:
- Pediatric Cardiology
- Neonatal Neurology
- Pharmacological Research
Background:
- Infantile spasms (IS) is a severe epilepsy syndrome in infants.
- Corticotropin is a common treatment for IS.
- Potential cardiac side effects of corticotropin require investigation.
Purpose of the Study:
- To assess the incidence of cardiac hypertrophy in infants treated with corticotropin for IS.
- To describe the clinical features of cardiac hypertrophy during this treatment.
Main Methods:
- Prospective echocardiographic study.
- Eighteen infants with IS treated with high-dose corticotropin.
- Cardiac structure and function assessed via echocardiography.
Main Results:
- Abnormal cardiac hypertrophy observed in 72% of patients (13/18).
- Five patients developed hypertrophic cardiomyopathy with asymmetric septal hypertrophy.
- Eight patients showed concentric left ventricular hypertrophy; five had no changes.
Conclusions:
- The majority of infants treated with corticotropin for IS develop abnormal ventricular hypertrophy.
- Hypertrophic cardiomyopathy occurred frequently but without significant outflow obstruction.
- Cardiac changes were reversible and did not impede corticotropin therapy.
Objective:
To evaluate the incidence and clinical features of abnormal cardiac hypertrophy during treatment of infantile spasms with corticotropin.
Design:
A prospective, echocardiographic study.
Participants:
Eighteen children treated for infantile spasms with high-dose corticotropin at a large tertiary children's hospital.
Interventions:
None.
Measurements And Results:
Abnormal cardiac hypertrophy was seen in 13 (72%) of 18 patients. Five of 18 patients (group 1) developed hypertrophic cardiomyopathy with asymmetric septal hypertrophy; none developed significant left ventricular outflow obstruction. Concentric left ventricular hypertrophy was seen in eight patients (group 2), whereas no changes were observed in five (group 3).
Conclusion:
Abnormal ventricular hypertrophy occurs in the majority of patients treated with corticotropin for infantile spasms. In our study, many of these patients developed hypertrophic cardiomyopathy with dramatic asymmetric septal hypertrophy; however, none developed significant obstruction to left ventricular outflow. All changes were reversible, and did not require premature discontinuation of therapy.