HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Azeka, E. Articles by Alcides Bocchi, E. Search for Related Content PubMed PubMed Citation Articles by Azeka, E. Articles by Alcides Bocchi, E.

CLINICAL STUDY

Delisting of infants and children from the heart transplantation waiting list after carvedilol treatment

^a Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil

Manuscript received March 11, 2002; revised manuscript received August 5, 2002, accepted August 26, 2002.

^* Reprint requests and correspondence: Dr. Estela Azeka, Rua Araripina 95, São Paulo, São Paulo, Brazil 05603-030.
estela_azeka9{at}hotmail.com

OBJECTIVES: We performed a prospective, randomized, double-blind, placebo-controlled study of carvedilol effects in children with severe, chronic heart failure (HF), despite the use of conventional therapy.

BACKGROUND: Little is known about the effects of carvedilol in youngsters with chronic HF and severe left ventricular (LV) dysfunction.

METHODS: We conducted a double-blind, placebo-controlled study of 22 consecutive children with severe LV dysfunction. The children had chronic HF and left ventricular ejection fraction (LVEF) <30%. Patients were randomly assigned to receive either placebo (8 patients) or the beta-blocker carvedilol (14 patients) at 0.01 mg/kg/day titrated up to 0.2 mg/kg/day, followed-up for six months.

RESULTS: During the follow-up and the up-titration period in the carvedilol group, four patients died and one underwent heart transplantation. In patients receiving carvedilol evaluated after six months, a significant increase occurred in LVEF, from 17.8% (95% confidence interval [CI], 14.1 to 21.4%) to 34.6% (95% CI, 25.2 to 44.0%); p = 0.001. Modified New York Heart Association (NYHA) functional class improved in nine patients taken off the transplant waiting list. All nine patients were alive at follow-up. In the placebo group, during the six-month follow-up, two patients died, and two underwent heart transplantation. Four patients persisted with HF symptoms (NYHA functional class IV). No significant change occurred in LVEF or fractional shortening.

CONCLUSIONS: Carvedilol added to standard therapy may reduce HF progression and improve cardiac function, allowing some youngsters to be removed from the heart transplantation waiting list.

Abbreviations and Acronyms   ANOVA   repeated-measures analysis of variance   FS   fractional shortening   HF   heart failure   LV   left ventricular/ventricle   LVDI   left ventricular diastolic index   LVEF   left ventricular ejection fraction   NYHA   New York Heart Association

This article has been cited by other articles:

				R. E. Shaddy, M. M. Boucek, D. T. Hsu, R. J. Boucek, C. E. Canter, L. Mahony, R. D. Ross, E. Pahl, E. D. Blume, D. A. Dodd, et al. Carvedilol for Children and Adolescents With Heart Failure: A Randomized Controlled Trial JAMA, September 12, 2007; 298(10): 1171 - 1179. [Abstract] [Full Text] [PDF]

				C. E. Canter, R. E. Shaddy, D. Bernstein, D. T. Hsu, M. R.K. Chrisant, J. K. Kirklin, K. R. Kanter, R. S.D. Higgins, E. D. Blume, D. N. Rosenthal, et al. Indications for Heart Transplantation in Pediatric Heart Disease: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young; the Councils on Clinical Cardiology, Cardiovascular Nursing, and Cardiovascular Surgery and Anesthesia; and the Quality of Care and Outcomes Research Interdisciplinary Working Group Circulation, February 6, 2007; 115(5): 658 - 676. [Abstract] [Full Text] [PDF]

				A. E. Tsirka, K. Trinkaus, S.-C. Chen, S. E. Lipshultz, J. A. Towbin, S. D. Colan, V. Exil, A. W. Strauss, and C. E. Canter Reply J. Am. Coll. Cardiol., May 17, 2005; 45(10): 1734 - 1734. [Full Text]