Hypertrophic cardiomyopathy associated with dexamethasone therapy for bronchopulmonary dysplasia

Werner, John C.; Sicard, Raymond E.; Hansen, Tonya Moen; Solomon, E.; Cowett, Richard M.; Oh, William

doi:10.1016/s0022-3476(05)80446-9

Cited by 135 publications

(77 citation statements)

References 10 publications

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“…Such changes are transient in premature infants, as they resolve within 1-2 weeks after discontinuation of the steroids. 1,2 In older infants and children, the course of resolution of ventricular hypertrophy may be longer, as demonstrated by our and other case reports, 3,4 emphasizing the need for a longer follow-up. Severe septal hypertrophy causes a Venturi effect, drawing the anterior mitral leaflet against the ventricular septum, resulting in left ventricular outflow obstruction and a pressure gradient.…”

Section: Discussionmentioning

confidence: 54%

Steroid-induced hypertrophic cardiomyopathy following stem cell transplantation in a neonate: a case report

Lesnik

Balfour

et al. 2001

Bone Marrow Transplant

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Summary:We report a case of severe left ventricular outflow tract obstruction complicating steroid therapy in an infant undergoing allogeneic transplant in the first few weeks of life for treatment of Krabbe's disease. While this complication is well known to those treating premature infants, it has not been reported in the stem cell transplant setting. For young infants undergoing allogeneic transplant who require steroid therapy, cardiac monitoring after 2-3 weeks of therapy is recommended. Bone Marrow Transplantation (2001) 27, 1105-1108.

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Section: Discussionmentioning

confidence: 54%

Steroid-induced hypertrophic cardiomyopathy following stem cell transplantation in a neonate: a case report

Lesnik

Balfour

et al. 2001

Bone Marrow Transplant

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“…Short-term adverse cardiovascular side effects of neonatal dexamethasone treatment, including hypertension and hypertrophic cardiomyopathy, are well documented both in experimental studies and in humans (7,8,17,28,29,35,39). However, possible detrimental long-term effects have not been studied in detail.…”

Section: Discussionmentioning

confidence: 99%

“…The short-term cardiovascular effects after neonatal dexamethasone treatment include hypertension and hypertrophic cardiomyopathy. These effects were described both in animal and human studies and are generally thought to be transient (7,8,17,28,29,35,39). However, recent data showed a significantly reduced life expectancy of rats treated with dexamethasone in the neonatal period, suggesting permanent damage and detrimental long-term effects (20).…”

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confidence: 99%

Long-term cardiovascular effects of neonatal dexamethasone treatment: hemodynamic follow-up by left ventricular pressure-volume loops in rats

Bal¹,

Vries²,

Oosterhout³

et al. 2008

Journal of Applied Physiology

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Bal MP, de Vries WB, van Oosterhout MF, Baan J, van der Wall EE, van Bel F, Steendijk P. Long-term cardiovascular effects of neonatal dexamethasone treatment: hemodynamic follow-up by left ventricular pressure-volume loops in rats. J Appl Physiol 104: 446-450, 2008. First published December 13, 2007 doi:10.1152/japplphysiol.00951.2007.-Dexamethasone is clinically applied in preterm infants to treat or prevent chronic lung disease. However, concern has emerged about adverse side effects. The cardiovascular short-term side effects of neonatal dexamethasone treatment are well documented, but long-term consequences are unknown. Previous studies showed suppressed mitosis during dexamethasone treatment, leading to reduced ventricular weight, depressed systolic function, and compensatory dilatation in prepubertal rats. In addition, recent data indicated a reduced life expectancy. Therefore, we investigated the long-term effects of neonatal dexamethasone treatment on cardiovascular function. Neonatal rats were treated with dexamethasone or received saline. Cardiac function was determined in 8-, 50-, and 80-wk-old animals, representing young adult, middle-aged, and elderly stages. A pressure-conductance catheter was introduced into the left ventricle to measure pressure-volume loops. Subsequently, the hearts were collected for histological examination. Our results showed reduced ventricular and body weights in dexamethasone-treated rats at 8 and 80 wk, but not at 50 wk. Cardiac output and diastolic function were unchanged, but systolic function was depressed at 50 and 80 wk, evidenced by reduced ejection fractions and rightward shifts of the end-systolic pressure-volume relationships. We concluded that previously demonstrated early adverse effects of neonatal dexamethasone treatment are transient but that reduced ventricular weight and systolic dysfunction become manifest again in elderly rats. Presumably, cellular hypertrophy initially compensates for the dexamethasone treatment-induced lower number of cardiomyocytes, but this mechanism falls short at a later stage, leading to systolic dysfunction. If applicable to humans, cardiac screening of a relatively large patient group to enable secondary prevention may be indicated. cardiac function; pressure-volume relations; rats; glucocorticoids GLUCOCORTICOIDS, in particular dexamethasone, are widely used to treat or prevent chronic lung disease in preterm infants. However, due to adverse long-term effects on cognition and motoneuron development, neonatal glucocorticoid treatment remains controversial (3). The American Academy of Pediatrics and the Canadian Pediatric Society recently published guidelines for the use of postnatal steroid treatment in preterm infants (1). With regard to the long-term effects on the brain, studies have documented adverse outcomes, including cerebral palsy and delayed and abnormal neurological development (5,6,12,18,41). The short-term cardiovascular effects after neonatal dexamethasone treatment include hypertension and hypertrophic cardiomyop...

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“…14 The risk for ventricular hypertrophy in infants with chronic lung disease is sufficiently high that periodic echocardiograms to assess for myocardial thickening is justified. 15 We suggest that surveillance for ventricular hypertrophy in this population will serve to identify patients at risk for subendocardial ischemia.…”

Section: Discussionmentioning

confidence: 99%

Subendocardial infarction associated with ventricular hypertrophy in preterm infants with chronic lung disease

et al. 2008

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Hypertrophic cardiomyopathy associated with dexamethasone therapy for bronchopulmonary dysplasia

Cited by 135 publications

References 10 publications

Steroid-induced hypertrophic cardiomyopathy following stem cell transplantation in a neonate: a case report

Steroid-induced hypertrophic cardiomyopathy following stem cell transplantation in a neonate: a case report

Long-term cardiovascular effects of neonatal dexamethasone treatment: hemodynamic follow-up by left ventricular pressure-volume loops in rats

Subendocardial infarction associated with ventricular hypertrophy in preterm infants with chronic lung disease

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