PDF herunterladen
Klin Padiatr 2015; 227(01): 3-9
DOI: 10.1055/s-0034-1389974
Review
© Georg Thieme Verlag KG Stuttgart · New York

Chronic Congestive Heart Failure in Infancy and Childhood: New Aspects of Diagnosis and Treatment

Herzversagen im Kindesalter: neue Aspekte der Diagnostik und Therapie
A. A. Schmaltz
1   Former: Clinic for Pediatric Cardiology, University Childrens Hospital, Essen, Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
07. Januar 2015 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Congestive heart failure (CHF) is the inability of the heart to meet the metabolic demands of the body. As a disease of the advanced age with a frequency of 1–2% of the population it is rare in infancy and childhood. The incidence ranges from 2.95 (in all US children’s hospitals) to 23.2 (University’s Childrens Hospital Essen) on 1 000 discharges. Among the diagnostic procedures echocardiography is the primary modality of imaging. Tei-index and tissue-Doppler are more sensitive parameters for LV-dysfunction. BNP/NT-proBNP are age-dependent and can guide the long-term therapy. Treatment in childhood does not differ basically from that in adulthood, recommended by several guidelines, but data regarding the various substances – outlined in detail – are very limited. Here a big work has to be done in future!

Zusammenfassung

Von Herzversagen spricht man, wenn das Herz nicht die metabolischen Bedürfnisse des Körpers decken kann. Als eine Erkrankung des höheren Alters mit einer Häufigkeit von 1–2% der Bevölkerung ist sie im Kindesalter selten. Die Inzidenz reicht von 2,95 (bei US-Kinderkliniken) bis 23,2 (Universitäskinderklinik Essen) auf 1 000 Entlassungen. Bei der Diagnostik ist die Echokardiografie die wesentlichste Methode der Bildgebung. Tei-Index und Gewebs-Doppler sind ausgesprochen sensitive Parameter der LV-Dysfunktion. BNP/NT-proBNP sind altersabhängig und können die Langzeittherapie steuern. Die Behandlung im Kindesalter unterscheidet sich nicht wesentlich von der des Erwachsenenalters, wie sie in mehreren Leitlinien empfohlen wird. Dabei ist die Datenlage und damit die Evidenzbasis bei den verschiedenen Substanzen, die im einzelnen ausgeführt werden, schlecht. Hier ist noch viel zu tun!

Key words

congestive heart failure - infancy and childhood - diagnosis - treatment

Schlüsselwörter

Herzversagen - Kindesalter - Diagnostik - Therapie
 

  • References

  • 1 Ahmed A, Rich MW, Love TE et al. Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. Eur Heart J 2006; 27: 178-186
    PubMedGoogle Scholar
  • 2 Allan HD, Driscoll DJ, Shaddy RE et al. Moss and Adams’ heart disease in infants, children and adolescents. 7 e. Wolters Kluwer, Lippincott 2007;
    PubMedGoogle Scholar
  • 3 http://www.awmf.org
    PubMed
  • 4 Azeka E, Franchini Ramires JA, Valler C et al. Delisting of infants and children from heart transplantation waiting list after carvedilol treatment. J Am Coll Cardiol 2002; 40: 2034-2038
    CrossrefPubMedGoogle Scholar
  • 5 Baylen BG, Johnson G, Tsang R et al. The occurrence of hyperaldosteronism in infants with congestive heart failure. Am J Cardiol 1980; 45: 305-310
    CrossrefPubMedGoogle Scholar
  • 6 Bayley N. Bayley scales and infant development. 2nd ed. San Antonio (TX): Psychol Corp; 1993
    Google Scholar
  • 7 Buchhorn R, Hulpke-Wette M, Hilgers R et al. Propranolol treatment of congestive heart failure in infants with congenital heart disease. The CHF-PRO-INFANT Trial. Int J Cardiol 2001; 79: 1176-1183
    PubMedGoogle Scholar
  • 8 Buck ML. Clinical experience with spironolactone in paediatrics. Ann Pharmacother 2005; 39: 823-828
    CrossrefPubMedGoogle Scholar
  • 9 Bruch C, Schmermund A, Marin D et al. Tei-index in patients with mild-to-moderate congestive heart failure. Eur Heart J 2000; 21: 1888-1895
    CrossrefPubMedGoogle Scholar
  • 10 Chang AC, Towbin JA. Heart failure in children and young adults. Saunders Elsevier, Philadelphia 2006;
    PubMedGoogle Scholar
  • 11 Connolly D, Rutkowski M, Auslender M et al. The New York University heart failure index: a new method of quantifying chronic heart failure severity in children. J Pediatr 2001; 138: 644-648
    CrossrefPubMedGoogle Scholar
  • 12 The Consensus trial study group. Effect of enalapril on mortality in severe congestive heart failure . Results of the Cooperative North Scandinavian Enalapril Survival Study (Consensus). N Engl J Med 1987; 316: 1429-1435
    CrossrefPubMedGoogle Scholar
  • 13 Cowley CG, Bradley JD, Shaddy RE. B-type natriuretic peptide levels in congenital heart disease. Pediatr Cardiol 2004; 25: 336-340
    PubMedGoogle Scholar
  • 14 Digitalis Investigation Group (DIG) . The effect of digoxin in mortality and morbidity in patients with heart failure. N Engl J Med 1997; 306: 525-533
    PubMedGoogle Scholar
  • 15 Elkiran O, Sandikkaya A, Kocak G et al. Evaluation by N-terminal prohormone of brain natriuretic peptide concentrations and Ross scoring of the efficacy of digoxin in the treatment of heart failure secondary to congenital heart disease with left-to-right shunts. Pediatr Cardiol 2013; 34: 1583-1589
    CrossrefPubMedGoogle Scholar
  • 16 Engle MA, Lewy JE, Lewy PR et al. The use of furosemide in the treatment of edema in infants and children. Pediatrics 1978; 62: 811-818
    PubMedGoogle Scholar
  • 17 Erdmann E. Pathophysiology of heart failure. Heart 1998; 79 (Suppl. 02) S3-S5
    CrossrefPubMedGoogle Scholar
  • 18 Faris RF, Flather M, Purcell H et al. Diuretics for heart failure. Cochrane Database of Systematic reviews 2012; CD003838
    PubMedGoogle Scholar
  • 19 Frobel AK, Hulpke-Wette M, Schmidt KG et al. Beta-blockers for congestive heart failure in children. Cochrane Database of Systematic reviews 2013; CD007037
    PubMedGoogle Scholar
  • 20 Garg R, Yusuf S, Bussmann WD et al. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbiditiy in patients with heart failure. J Am Med Ass 1995; 273: 1450-1456
    CrossrefPubMedGoogle Scholar
  • 21 Gidding SS. The importance of randomized controlled trials in pediatric cardiology. J Am Med Ass 2007; 298: 1214-1216
    CrossrefPubMedGoogle Scholar
  • 22 Hobbins SM, Fowler RS, Rowe R et al. Spironolactone therapy in infants with congestive heart failure secondary to congenital heart disease. Arch Dis Childh 1981; 56: 934-938
    CrossrefPubMedGoogle Scholar
  • 23 Hoppe UC, Böhm M, Dietz R et al. Leitlinien zur Therapie der chronischen Herzinsuffizienz. Z Kardiol 2005; 94: 488-509
    CrossrefPubMedGoogle Scholar
  • 24 Hougen TJ. Digitalis use in children: an uncertain future. Progr Pediatr Cardiol 2000; 12: 37-43
    CrossrefPubMedGoogle Scholar
  • 25 Hsu DT, Mital S, Ravishankar C et al. Rationale and design of a trial of angiotensin-converting enzyme inhibition in infants with single ventricle. Am Heart J 2009; 157: 37-45
    CrossrefPubMedGoogle Scholar
  • 26 Hsu DT, Pearson GD. Heart failure in children. Part I: History, etiology, and pathophysiology. Circ Heart Fail 2009; 2: 63-70 Part II: Diagnosis, treatment, and future directions. Circ Heart Fail 2009; 2: 490-498
    CrossrefPubMedGoogle Scholar
  • 27 Hsu DT, Zak V, Mahony L et al. Enalapril in infants with single ventricle. Results of a multicenter randomized trial. Circulation 2010; 122: 333-340
    PubMedGoogle Scholar
  • 28 Huang M, Zhang X, Chen S et al. The effect of carvedilol treatment on chronic heart failure in pediatric patients with dilated cardiomyopathy: a prospective, randomized-controlled study. Pediatr Cardiol 2013; 34: 680-685
    CrossrefPubMedGoogle Scholar
  • 29 Kannel WB. Incidence and epidemiology of heart failure. Heart failure reviews 2000; 5: 167-173
    CrossrefPubMedGoogle Scholar
  • 30 Kantor PF, Lougheed J, Dancea A et al. Presentation, diagnosis, and medical management of heart failure in children: Canadian cardiovascular society guidelines. Can J Cardiol 2013; 29: 1535-1552
    CrossrefPubMedGoogle Scholar
  • 31 Kao LC, Warburton D, Cheng MH et al. Effect of oral diuretics on pulmonary mechanics in infants with chronic bronchopulmonary dyplasia: results of a double-blind crossover sequential trial. Pediatrics 1984; 74: 37-44
    PubMedGoogle Scholar
  • 32 Kim G, Lee OJ, Kang IS et al. Clinical implications of serial serum N-terminal prohormone brain natriuretic peptide levels in the prediction of outcome in children with dilated cardiomyopathy. Am J Cardiol 2013; 112: 1455-1460
    CrossrefPubMedGoogle Scholar
  • 33 Koch A, Singer H. Normal values of B type natriuretic peptide in infants, children and adolescents. Heart 2003; 89: 875-878
    CrossrefPubMedGoogle Scholar
  • 34 Koch A, Zink S, Singer H. B-type natriuretic peptide in paediatric patients with congenital heart disease. Eur Heart J 2006; 27: 861-866
    CrossrefPubMedGoogle Scholar
  • 35 Läer S, Mir TS, Behn F et al. Carvedilol therapy in pediatric patients with congestive heart failure: a study investigating clincal and pharmacokinetic parameters. Am Heart J 2002; 143: 916-922
    CrossrefPubMedGoogle Scholar
  • 36 Lang RM, Bierig M, Deveruex RB et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee. J Am Soc Echocardiogr 2005; 18: 1440-1463
    CrossrefPubMedGoogle Scholar
  • 37 Leversha AM, Wilson NJ, Clarkson PM et al. Efficacy and dosage of enalapril in congenital and acquired heart disease. Arch Dis Child 1994; 70: 35-39
    CrossrefPubMedGoogle Scholar
  • 38 Lewis AB, Chabot M. The effect of treatment with angiotensin-converting enzyme inhibitors on survival of pediatric patients with dilated cardiomyopathy. Pediatr Cardiol 1993; 14: 9-12
    PubMedGoogle Scholar
  • 39 Mangat J, Carter C, Riley G et al. The clinical utility of brain natriuretic peptide in paediatric left ventricular failure. Eur J Heart Failure 2009; 11: 48-52
    CrossrefPubMedGoogle Scholar
  • 40 McMahon CJ, Nagueh SF, Eapen RS et al. Echocardiographic predictors of adverse clinical events in children with dilated cardiomyopathy: a prospective clinical study. Heart 2004; 90: 908-915
    CrossrefPubMedGoogle Scholar
  • 41 McMurray JJV, Adamopoulos S, Anker SD et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. The Task force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Eur Heart J 2012; 33: 1787-1847
    CrossrefPubMedGoogle Scholar
  • 42 Miyamoto SD, Stauffer BL, Nakano S et al. Beta-adrenergic adaptation in pediatric idiopathic dilated cardiomyopathy. Eur Heart J 2014; 35: 33-41
    CrossrefPubMedGoogle Scholar
  • 43 Mir TS, Flato M, Falkenberg J et al. Plasma concentrations of N-terminal brain natriuretic peptide in healthy children, adolescents, and young adults: effect of age and gender. Pediatr Cardiol 2006; 27: 73-77
    CrossrefPubMedGoogle Scholar
  • 44 Nir A, Lindinger A, Rauh M et al. NT-pro-B-type natriuretic peptide in infants and children: reference values based on combined data from four studies. Pediatr Cardiol 2009; 30: 3-8
    CrossrefPubMedGoogle Scholar
  • 45 Nishii M, Inomata T, Takehana H et al. Prognostic utility of B-type natriuretic peptide assessment in stable low-risk outpatients with non-ischemic cardiomyopathy after decompensated heart failure. J Am Coll Cardiol 2008; 51: 2329-2335
    CrossrefPubMedGoogle Scholar
  • 46 Norozi K, Bahlmann J, Raab B et al. A prospective, randomized, double-blind, placebo controlled trial of beta-blockade in patients who have undergone surgical correction of tetralogy of Fallot. Cardiol Young 2007; 17: 372-379
    CrossrefPubMedGoogle Scholar
  • 47 Patel DR, Cui W, Gambetta K et al. A comparison of Tei index versus systolic and diastolic ratio to detect left ventricular dysfunction in pediatric patients. J Am Soc Echocardiogr 2009; 22: 152-158
    CrossrefPubMedGoogle Scholar
  • 48 Patel MS, Berg AM, Vincent RN et al. Serum parameters and echocardiographic predictors of death or need for transplant in newborns, children and young adults with heart failure. Am J Cardiol 2010; 105: 1798-1801
    CrossrefPubMedGoogle Scholar
  • 49 Petko C, Minnich LL, Everit MD et al. Echocardiographic evaluation of children with systemic ventricular dysfunction treated with carvedilol. Pediatr Cardiol 2010; 31: 780-784
    CrossrefPubMedGoogle Scholar
  • 50 Pitt B, Zannad F, Remme WJ et al. The effect of spironolactone on morbiditiy and mortality in patients with severe heart failure. N Engl J Med 1999; 341: 709-717
    Google Scholar
  • 51 Rodeheffer RJ, Jacobsen SJ, Gersh BJ et al. The incidence and prevalence of congestive heart failure in Rochester, Minnesota. Mayo Clin Proc 1993; 68: 1143-1150
    CrossrefPubMedGoogle Scholar
  • 52 Ross RD, Daniels SR, Schwartz DC et al. Plasma levels of norepinephrine in infants and children with congestive heart failure. Am J Cardiol 1987; 59: 911-914
    CrossrefPubMedGoogle Scholar
  • 53 Ross R. The Ross classification for heart failure in children after 25 years: a review and an age-stratified revision. Pediatr Cardiol 2012; 33: 1295-1300
    CrossrefPubMedGoogle Scholar
  • 54 Rossano JW, Kim JJ, Decker JA et al. Prevalence, morbidity, and mortality of heart failure-related hospitalizations in children in the United States: a population-based study. J Card Fail 2012; 18: 459-470
    CrossrefPubMedGoogle Scholar
  • 55 Rossano JW, Shaddy RE. Update on pharmacological heart failure therapies in children. Do adult medications work in children and if not, why not? Circulation 2014; 129: 607-612
    PubMedGoogle Scholar
  • 56 Savarese G, Trimarco B, Dellegrottaglie S et al. Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials. PloS One 2012; 8: 258-287
    PubMedGoogle Scholar
  • 57 Schmaltz AA. Herzinsuffizienz im Kindesalter. Klin Padiatr 1999; 211: 1-10
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 58 Schmaltz AA. ed. Deutsche Gesellschaft für Pädiatrische Kardiologie: Leitlinien zur Diagnostik und Therapie in der Pädiatrischen Kardiologie. Elsevier, Urban und Fischer; München: 2007
  • 59 Shaddy RE, Boucek MM, Hsu DT et al. Carvedilol for children and adolescents with heart failure – a randomized controlled trial. J Am Med Ass 2007; 298: 1171-1179
    CrossrefPubMedGoogle Scholar
  • 60 Shaddy RE. Randomized clinical trials and the treatment of pediatric cardiomyopathy. Progr Ped Cardiol 2011; 31: 7-11
    PubMedGoogle Scholar
  • 61 Sommers C, Nagel BHP, Neudorf U et al. Herzinsuffizienz im Kindesalter – eine epidemiologische Studie. Herz 2005; 30: 652-662
    CrossrefPubMedGoogle Scholar
  • 62 The SOLVD investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991; 325: 293-302
    CrossrefPubMedGoogle Scholar
  • 63 Stern H, Weil J, Genz T et al. Captopril in children with dilated cardiomyopathy: acute and long-term effects in a prospective study of hemodynamic and hormonal effects. Pediatr Cardiol 1990; 11: 22-28
    CrossrefPubMedGoogle Scholar
  • 64 Tabutt S, Nord AS, Jarvik GP et al. Neurodevelopmental outcomes after staged palliation for hypoplastic left heart syndrome. Pediatrics 2008; 121: 476-483
    CrossrefPubMedGoogle Scholar
  • 65 Van der Hulst AE, Delgado V, Blom NA et al. Cardiac resynchronization therapy in paediatric and congenital heart disease patients. Eur Heart J 2011; 32: 2236-2246
    CrossrefPubMedGoogle Scholar
  • 66 Wernovsky G, Hoffman TM. Pediatric heart failure management: solving the puzzle. Crit Care Med 2001; 29: S212-S241
    CrossrefPubMedGoogle Scholar
  • 67 Webster G, Zhang J, Rosenthal D. Comparison of the epidemiology and co-morbidities of heart failure in the pediatric and adult populations: a retrospective, cross-sectional study. BMC Cardiovasc Disorders 2006; 6: 23-29
    PubMedGoogle Scholar
  • 68 www.kompetneznetz-ahf.de
    PubMed
  • 69 Yancy CW, Jessup M, Bozkurt B et al. 2013 ACCF/AHA Guideline for the management of heart failure. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 125: e240-e327
    PubMedGoogle Scholar
  • 70 Zannad F, McMurray JJV, Krum H et al. Eplerenone in patients with systolic heart failure and mild symptoms. New Engl J Med 2011; 364: 11-21
    CrossrefPubMedGoogle Scholar