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Upgraded heart failure therapy leads to an improved outcome of dilated cardiomyopathy in infants and toddlers

Published online by Cambridge University Press:  12 December 2014

Stefan Rupp ,
Christian Apitz ,
Leonie Tholen ,
Heiner Latus ,
Stefan H. Ostermayer ,
Dorle Schmidt ,
Jürgen Bauer  and
Dietmar Schranz
Stefan Rupp*
Affiliation:
Pediatric Heart Center, University of Giessen and Marburg, Giessen, Germany Department of Pediatrics, Klinikum Kempten, Kempten, Germany
Christian Apitz
Affiliation:
Pediatric Heart Center, University of Giessen and Marburg, Giessen, Germany
Leonie Tholen
Affiliation:
Pediatric Heart Center, University of Giessen and Marburg, Giessen, Germany
Heiner Latus
Affiliation:
Pediatric Heart Center, University of Giessen and Marburg, Giessen, Germany
Stefan H. Ostermayer
Affiliation:
Pediatric Heart Center, University of Giessen and Marburg, Giessen, Germany
Dorle Schmidt
Affiliation:
Pediatric Heart Center, University of Giessen and Marburg, Giessen, Germany
Jürgen Bauer
Affiliation:
Pediatric Heart Center, University of Giessen and Marburg, Giessen, Germany
Dietmar Schranz
Affiliation:
Pediatric Heart Center, University of Giessen and Marburg, Giessen, Germany
*
Correspondence to: S. Rupp, Pediatric Heart Center, University of Giessen and Marburg, Feulgenstrasse 12, 35392 Giessen, Germany. Tel: +49 641 994 3461; Fax: +49 641 994 3469; E-mail: stefan.rupp@paediat.med.uni-giessen.de
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Abstract

Objective

Dilated cardiomyopathy is a leading cause of cardiac death in children. Approximately 30% of children die or need cardiac transplantation in the first year after establishing the diagnosis. New strategies are needed to improve the outcome in this high-risk patient population.

Method and results

We present our experience in 38 patients below the age of three years, who were diagnosed with dilated cardiomyopathy and who were treated at our institution between 2006 and 2012. The treatment strategy involved institution of β-blockers and angiotensin-converting enzyme inhibitors as soon as feasible. In selected cases, pulmonary artery banding or intracoronary autologous bone marrow-derived cell therapy was performed. The median age at presentation was six months (range 1–26 months). The median follow-up age was 16 months (range 2–80 months). Kaplan–Meier analysis of survival after dilated cardiomyopathy diagnosis revealed a one-year survival of 97% and a five-year survival of 86%. The rate of freedom from death or heart transplantation was 82% at one year and 69% at five years. Surviving patients who were free of transplantation, at the follow-up at 25 months (3–80 months), showed a significant improvement in left ventricular ejection fraction (from 19±11 to 46±16%) and left ventricular end-diastolic diameter (z-score from 4.6±2.4 to 1.4±1.6). In addition, the levels of B-type natriuretic peptide improved significantly (from 3330±3840 to 171±825 pg/ml).

Conclusion

Our data suggest that the clinical approach described here may result in a markedly improved medium-term outcome in young children with dilated cardiomyopathy. Further studies are required to evaluate whether these approaches reduce end-points such as transplantation or death.

Keywords

Dilated cardiomyopathyheart failureβ-blockerangiotensin-converting enzyme inhibitorpulmonary artery bandingchildren
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 7 , October 2015 , pp. 1300 - 1305
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Copyright
© Cambridge University Press 2014 

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