Beta-blocker treatment of dilated cardiomyopathy with congestive heart failure in children: a multi-institutional experience

• Published in: The Journal of heart and lung transplantation Vol. 18; no. 3; pp. 269 - 274
• Main Authors: Shaddy, Robert E, Tani, Lloyd Y, Gidding, Samuel S, Pahl, Elfriede, Orsmond, Garth S, Gilbert, Edward M, Lemes, Vicente
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.1999; Elsevier Science
• Subjects: Adolescent; Adrenergic beta-Antagonists - therapeutic use; Biological and medical sciences; Cardiomyopathy, Dilated - complications; Cardiomyopathy, Dilated - drug therapy; Cardiomyopathy, Dilated - physiopathology; Cardiotonic agents; Cardiovascular system; Child; Child, Preschool; Echocardiography; Heart Failure - complications; Heart Failure - drug therapy; Heart Failure - physiopathology; Humans; Medical sciences; Metoprolol - therapeutic use; Pharmacology. Drug treatments; Stroke Volume; Ventricular Function, Left; Human; Heart failure; Cardiotonic agent; Cardiac performance; Metoprolol; Treatment efficiency; Cardiovascular disease; Chemotherapy; Treatment; Congestive hypertrophic cardiomyopathy; Heart disease; Complication; Child; Beta blocking agent
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/S1053-2498(98)00030-8

Dilated cardiomyopathy is the primary indication for heart transplantation in children beyond infancy. Although beta-blockers improve symptoms, ejection fraction, and survival in adults with congestive heart failure, little is known of their effects in children. This study reviews our pediatric experience with the beta-blocker, metoprolol, at 3 institutions. We gave metoprolol to 15 children, age 8.6 ± 1.3 years (range 2.5 to 15 years), with idiopathic dilated cardiomyopathy (n = 9), anthracycline cardiomyopathy (n = 3), and Duchenne muscular dystrophy cardiomyopathy, post-myocarditis cardiomyopathy, and post-surgical cardiomyopathy (n = 1 each). All had been treated with conventional medications (digoxin, diuretics, and ACE inhibitors) for 22.5 ± 9 months before starting metoprolol. Metoprolol was started at 0.1 to 0.2 mg/kg/dose given twice daily and slowly increased over a period of weeks to a dose of 1.1 ± 0.1 mg/kg/day (range 0.5 to 2.3 mg/kg/day). Between the time point of stabilization on conventional medications and the initiation of metoprolol therapy, there was no significant change in fractional shortening (13.1 ± 1.2% vs 15.0 ± 1.2%) or ejection fraction (25.6 ± 2.1% vs 27.0 ± 3.4%). However, after metoprolol therapy for 23.2 ± 7 months, there was a significant increase in fractional shortening(23.3 ± 2.6%) and ejection fraction (41.1 ± 4.3%) ( p < 0.05). Metoprolol improves ventricular function in some children with dilated cardiomyopathy and congestive heart failure. Further study is warranted to better define which children may benefit most from beta-blocker therapy and which beta-blockers are most efficacious.