Beta-blocker treatment of dilated cardiomyopathy with congestive heart failure in children: A multi-institutional experience

Background: Dilated cardiomyopathy is the primary indication for heart transplantation in children beyond infancy. Although beta-blockers improve symptoms, ejection fraction, and survival in adults with congestive heart failure, little is known of their effects in children. Methods: This study reviews our pediatric experience with the beta-blocker, metoprolol, at 3 institutions. We gave metoprolol to 15 children, age 8.6 ± 1.3 years (range 2.5 to 15 years), with idiopathic dilated cardiomyopathy (n = 9), anthracycline cardiomyopathy (n = 3), and Duchenne muscular dystrophy cardiomyopathy, postmyocarditis cardiomyopathy, and post-surgical cardiomyopathy (n = 1 each). All had been treated with conventional medications (digoxin, diuretics, and ACE inhibitors) for 22.5 ± 9 months before starting metoprolol. Metoprolol was started at 0.1 to 0.2 mg/kg/dose given twice daily and slowly increased over a period of weeks to a dose of 1.1 ± 0.1 mg/kg/day (range 0.5 to 2.3 mg/kg/day). Results: Between the time point of stabilization on conventional medications and the initiation of metoprolol therapy, there was no significant change in fractional shortening (13.1 ± 1.2% vs 15.0 ± 1.2%) or ejection fraction (25.6 ± 2.1% vs 27.0 ± 3.4%). However, after metoprolol therapy for 23.2 ± 7 months, there was a significant increase in fractional shortening (23.3 ± 2.6%) and ejection fraction (41.1 ± 4.3%) (p < 0.05). Conclusions: Metoprolol improves ventricular function in some children with dilated cardiomyopathy and congestive heart failure. Further study is warranted to better define which children may benefit most from beta-blocker therapy and which betablockers are most efficacious.