- 作者：Etsuko Tsuda ; MD ; PhD ; etsuda@ncvc.go.jp" class="auth_mail" title="E-mail the corresponding author ; etsuda@hsp.ncvc.go.jp" class="auth_mail" title="E-mail the corresponding author ; Jun Negishi ; MD ; Kanae Noritake ; MD ; Toru Iwasa ; MD ; Tadaaki Abe ; MD ; PhD
- 关键词：Dilated cardiomyopathy ; Carvedilol ; Brain natriuretic peptide ; Heart failure ; Left ventricular reverse remodeling
- 刊名：Journal of Cardiology
- 出版年：2016
- 出版时间：February 2016
- 年：2016
- 卷：67
- 期：2
- 页码：147-152
- 全文大小：805 K
Methods
We reviewed the medical records of 5 infants around 12 months old referred to our hospital with severe heart failure due to DCM. Increased left ventricular fractional shortening (LVFS) by more than 10% and the percent of normal of left ventricular end-diastolic dimension (%LVDd) less than 120% were defined as LVRR in this study.
Results
DCM onset ranged from 8 to 16 months. Initial treatment of their acute heart failure was successful in all 5 but 4 patients relapsed despite the usual dose of carvedilol (induction 0.02–maintenance 0.4 mg/kg/day), and developed worsening heart failure. Brain natriuretic peptide (BNP) levels which increased again after the acute treatment had fallen subsequent to discontinuing or decreasing carvedilol. Over 24 months, LVFS had increased from 11 ± 2% (mean ± SD) to 34 ± 5% (p < 0.05), and %LVDd decreased from 149 ± 27% to 108 ± 11% (p < 0.05).
Conclusions
LVRR was found at 2 years after the onset of DCM. Usual dose induction of carvedilol therapy can sometimes worsen heart failure after successful initial conventional treatment for the acute heart failure in DCM. Close control of carvedilol treatment may determine the prognosis of infantile DCM around 12 months old. It is prudent to increase low-dose carvedilol slowly corresponding with the BNP level.