Pharmacological Heart Failure Therapy in Children: Focus on Inotropic Support

Schranz, Dietmar

doi:10.1007/164_2019_267

Cited by 1 publication

(3 citation statements)

References 79 publications

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“…After decision to PAB, levosimendan (0.1 µg/kg/min) without a loading dose was additionally infused for 24 h, beginning 12 h prior to PAB placement. This is consistent with our institutional protocol [ 9 ], including differential use of cardiovascular drugs in DCM-induced pHF in infancy [ 7 , 12 ]. The indication for PAB was based on age, normal RV function (TAPSE 12 mm) and the distinct left-right displacement of the interventricular septum shift by the ‘apple-shaped’ dilated left ventricle (LV) with a z score of the LVEDD > 5.…”

Section: Key Pointssupporting

confidence: 86%

“…After decision to PAB, levosimendan (0.1 µg/kg/min) without a loading dose was additionally infused for 24 h, beginning 12 h prior to PAB placement. This is consistent with our institutional protocol [9], including differential use of cardiovascular drugs in DCM-induced pHF in infancy [7,12] when cardiomyocytes are at their peak in mitosis and cytokinesis [14]. Reducing β-adrenergic signaling is a cornerstone to avoid cytokinesis failure [15].…”

supporting

confidence: 75%

“…1, are almost typical for infants and quite different from older children and young adults. However, the chances of recovery are so enormous that it is time to integrate the peculiarities of age and disease [18] into a thoughtful treatment strategy that includes concomitant drug treatment [7][8][9][10][11][12][13]. 'Heart failure' is not a syndrome, but a sequence of symptoms.…”

mentioning

confidence: 99%

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Can Pediatric Heart Failure Therapy Be Improved? Yes It Can, But…

Schranz

2022

Pediatr Drugs

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Given the heterogenous etiology of pediatric heart failure (pHF), evidence-based studies improving pHF are unlikely. A paradigm shift towards updated medicine-based evidence is therefore necessary. In view of the life expectancy of children, cardiac regeneration strategies are required. Therefore, age-and disease-related differences in myocardial (receptor) physiology require individualized precision medicine. First-line diuretic therapy, adopted from the treatment of adults with HF with no chance for recovery, should be questioned in the treatment of pHF with potential for recovery. Inadequate use of diuretics is a common reason for additional stimulation of the neurohumoral axis. Consecutive intravascular volume depletion led to an inadequate treatment with β-blocker and renin-angiotensin-aldosterone antagonists. Given the age-related catecholaminedriven cardiovascular (patho-) physiology, highly selective β1-blockers (bisoprolol) protect against β1-(noradrenaline)-related myocytic apoptosis and necrosis, but allow β2-receptor-mediated myocardial regeneration. Based on its high safety-efficacy profile with rarely seen adverse effects but easily monitorable efficacy by the surrogate of heart rate (reduction), bisoprolol is our first-line drug in infancy. Reduced heart rate economizes the heart and full body oxygen consumption and extends the diastolic filling and coronary perfusion time. Based on our many years of institutional experience, physicians should be encouraged to use β1-selected blockers in infants with dilated cardiomyopathy and hypoplastic left heart syndrome after stage-1 procedure, but also to treat ventricular septal defects with a significant left-to-right shunt. In summary, individualized pHF therapy is the prerequisite for a causal treatment to improve HF symptoms, but above all for the most functional regeneration possible.

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Section: Key Pointssupporting

confidence: 86%

“…After decision to PAB, levosimendan (0.1 µg/kg/min) without a loading dose was additionally infused for 24 h, beginning 12 h prior to PAB placement. This is consistent with our institutional protocol [9], including differential use of cardiovascular drugs in DCM-induced pHF in infancy [7,12] when cardiomyocytes are at their peak in mitosis and cytokinesis [14]. Reducing β-adrenergic signaling is a cornerstone to avoid cytokinesis failure [15].…”

supporting

confidence: 75%