Document Detail


Effects of therapeutic beta blockade on myocardial function and cardiac remodelling in congenital cardiac disease.
MedLine Citation:
PMID:  12691286     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cardiac remodelling is now recognised as an important aspect of cardiovascular disease progression and is, therefore, emerging as a therapeutic target in cardiac failure due to different etiologies. Little is known about the influence of different therapies for cardiac failure on the remodelling seen in infants with congenital cardiac disease. METHODS: During follow-up of a prospective and randomized trial, we investigated therapeutic effects on neurohormonal activation, ventricular function, and myocardial gene expression. We compared the data from 8 infants with severe congestive heart failure due to left-to-right shunts, who received digoxin and diuretics alone, to 9 infants who received additional treatment with propranolol. RESULTS: In these infants, beta-adrenergic blockade significantly reduced highly elevated levels of renin, from 284 +/- 319 microU/ml compared to 1061 +/- 769 microU/ml. Systolic ventricular function was normal in both groups, but diastolic ventricular function was improved in those receiving propranolol, indicated by significantly lower left atrial pressures, lower end-diastolic pressures, and less pronounced ventricular hypertrophy, the latter estimated by lower ratios of myocardial wall to ventricular cavity areas on average of 42%. Further hemodynamic parameters showed no significant differences between the groups, except for the lower heart rate in infants treated with propranolol. In those treated with digoxin and diuretics, there was a significant downregulation of beta2-receptor and angiotensin-2 receptor genes, and up-regulation of endothelin A receptor and connective tissue growth factor genes, that were partially prevented by additional treatment with propranolol. CONCLUSIONS: Beta-blockade is a new therapeutic approach for congestive heart failure in infants with congenital cardiac disease, producing with significant benefits on neurohormonal activation, diastolic ventricular function, and cardiac remodelling.
Authors:
Reiner Buchhorn; Martin Hulpke-Wette; Wolfgang Ruschewski; Robert D Ross; Jens Fielitz; Reinhard Pregla; Roland Hetzer; Vera Regitz-Zagrosek
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Cardiology in the young     Volume:  13     ISSN:  1047-9511     ISO Abbreviation:  Cardiol Young     Publication Date:  2003 Feb 
Date Detail:
Created Date:  2003-04-14     Completed Date:  2003-07-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9200019     Medline TA:  Cardiol Young     Country:  England    
Other Details:
Languages:  eng     Pagination:  36-43     Citation Subset:  IM    
Affiliation:
Department of Pediatric Cardiology, Georg-August-University, Göttingen, Germany. rbuchho@gwdg.de
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / administration & dosage*
Digoxin / administration & dosage*
Diuretics / administration & dosage*
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Therapy, Combination
Female
Heart Defects, Congenital / complications*,  diagnosis
Heart Failure / drug therapy*,  etiology,  mortality
Heart Function Tests
Hemodynamics / drug effects
Humans
Infant
Male
Probability
Prognosis
Propranolol / administration & dosage*
Prospective Studies
Reference Values
Risk Assessment
Severity of Illness Index
Statistics, Nonparametric
Survival Rate
Treatment Outcome
Ventricular Remodeling / drug effects*
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Diuretics; 20830-75-5/Digoxin; 525-66-6/Propranolol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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