The effect of carvedilol treatment om CHF in pediatric patients with DCM

1. The Effect of Carvedilol Treatment on
Chronic Heart Failure in Pediatric
Patients with Dilated Cardiomyopathy
: A Prospective, randomized-
controlled study
Dian Puspita
Pediatric Cardiology Division
Department of Cardiology and Cardiovascular Medicine
Faculty of Medicine Andalas University
M.Djamil Hospital Padang

2. Introduction
DCM
chronic heart
failure
• reported incidence of 3.3-7.3 per million
• 71–79 % DCM  chronic heart failure
The use of beta-adrenergic
blocking agents
(Carvedilol)for the
treatment of heart failure
• experience with the drug in
pediatric patients is limited
• its effectiveness and safety
remain to be confirmed.

3. Subjects
January
2008 -
December
2010, 112
pts DCM.
89 pts met
criteria &
participate
d in the
trial.
12 pat
lost 77
patients in
the final
analyses.
carvedilol-
treated
group
Methods
control
group

4. Inclusion and Exclusion Criteria
Inclusion
Age:1 month to 18 yo
Chronic heart failure
grade 2 or 3 heart
function (Ross criteria)
at least 1 month of
conventional treatment
LVEF less than 45 %
Exclusion
secondary DCM
grade 1 heart function or other unstable
conditionsevere atrioventricular regurgitation or
ventricular outflow obstruction
severe ECG abnormalities
Low systolic blood pressure
a low resting heart rate
renal or hepatic insufficiency
oversensitivity to beta-blockers.

5. control
group
carvedilol
group
studyTrial
initial dose 0.1 (mg/kg day)
doubled every 2 weeks until the
highest tolerated dose (< 0,8
mg/kgday)
not increased
in infection, low HR, 50%
improvement in heart fx and LVEF
After discharge, the patients were
followed regularly by cardiologists.
ameliorated
Unchanged
Deteriorated

6. Statistical Analysis
All data are presented as means ± standard deviations.
using the Statistical Package for the Social Sciences, version 16.0 (SPSS, Chicago, IL,
USA) and included t tests for comparisons of measured data between groups and the
Chi square test for
between-group comparisons of enumerated data.
A P value lower than 0.05 was considered statistically
significant.

7. Results
Heart Function
decreases in Ross
scores
- 11.94 % for the
experimental
group
- 2.81 % for the
control group
Echocardiography
Brain Natriuretic
Peptide
Clinical Results
improvement
- 40 %experimental
- 35.2 % control
deterioration
- 25 %experimental
- 37.8 % control
Drug Safety

8. Discussion
Chronic Heart Failure
myocardial cell
damage
ventricular
remodeling
sympathetic
nervous system
RAA
system
beta-blockers

9. Three types of
beta-blockers
carvedilol
a1,b1, and b2
receptors
nitric oxide antioxidants
bisoprolol metoprolol

10. Last Studies
Shaddy in 1998
Blume et al
Li et al
Matiteu et al

11. Limitation
number of cases in this report is small
the drug’s effective dose requires additional exploration
significant clinical efficacy usually appears after 2–3 months of beta-blocker therapy
in adult patients
the etiology of cardiomyopathy in pediatric patients is significantly different from that in
adult patients,

12. improvements in cardiac function, as indicated by Ross scores, echocardiography,
and decreased serum BNP levels
Hepatic and renal function abnormalities did not occur in any patients during the
treatment regimen
carvedilol is relatively safe for use in pediatric populations.

13. 13

14. 1. THE TITLE:
INTERESTING OR
USEFUL ?
YES
How efficacy and safety in using carvedilol for the
treatment Chronic Heart Failure in Pediatrics
Patient with dilated cardiomyopathy

15. 2. THE AUTHORS:
GOOD TRACK
RECORD ?
DIRECTLY
DON’T
KNOW
THE ARTICLE WAS TAKEN FROM FAMOUS
INTERNATIONAL PUBLISHED JOURNAL
BUT

16. 3. THE SUMMARY:
IF VALID, WOULD
THESE
RESULTS BE
USEFUL ?
The study showed that an improvement in the cardiac
function of the patients who treat with carvedilol and
carvedilol is relatively safe for use in pediatric pts.
YES

17. 4. CONSIDER THE
SITE:
IF VALID, WOULD
THESE
RESULTS APPLY IN
YOUR
PRACTICE ?
YES
Some of the results of this study can apply in our
practice

18. 18
PATIENTS
AND
METHODS
SECTION
Step Two:
Deciding whether the basic methods used
were strong or weak ?

19. 19

22. 22

23. Pathophysiology Of The Heart Disease, Lily

24. Pathophysiology Of The Heart Disease, Lily

25. British Hypertension Society

26. Moss and Adams Heart Disease in Infants, Children, and
adolescent,

27. 6

28. 11

30. 14

31. 3

32. 8

33. 9

34. 15