Carvedilol in children with cardiomyopathy:: 3-year experience at a single institution

Background: Carvedilol reduces mortality and hospitalization in adults with congestive heart failure. Limited information is available about its use in children. Methods: We reviewed the medical records of 24 children with dilated cardiomyopathy and left ventricular ejection fraction of less than or equal to40%, who were treated with carvedilol as adjunct therapy to angiotensin-converting enzyme inhibitors, digoxin and diuretics. Results: Carvedilol was initiated 14.3 +/- 23.3 (mean +/- SD) months after the diagnosis of cardiomyopathy. Mean age at initiation of therapy was 7.2 +/- 6.4 years. The mean initial and maximum doses were 0.15 +/- 0.09 and 0.98 +/- 0.26 mg/kg/day. Adverse effects occurred in 5 patients (21%). Two patients (8%) required discontinuation of the drug within 5 weeks of the initial dose. The remaining 22 patients tolerated carvedilol for a mean follow-up period of 26.6 +/- 14.7 months. Among these 22 patients, mean left ventricular ejection fraction improved from 24.6 +/- 7.6% to 42.2 +/- 14.2% (p < 0.001), and mean sphericity index from 0.86 +/- 0.11 to 0.74 +/- 0.10 (p < 0.001). New York Heart Association functional class improved in 15 patients (68%). One patient (4%) died and 3 (14%) were transplanted. Conclusions: Carvedilol, in addition to standard therapy for dilated cardiomyopathy in children improves cardiac function and symptoms; it is well tolerated, with minimal adverse effects, but close monitoring is necessary as it might worsen congestive heart failure and precipitate asthma. Control studies are necessary to assess the effect of carvedilol on mortality and hospitalization rates.