Potential of AT1-R-Biased Agonists in Pediatric Heart Failure

T he pharmacological treatment of heart fail- ure (HF) in adults, especially those with chronic HF with reduced ejection fraction (HFrEF), is well-worn territory (1).The use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ARBs), beta-adrenergic receptor blockers, aldosterone antagonists, and diuretic agents are the mainstays of pharmacological management.However, this is not to say that current therapeutic modalities are either optimal or that newer avenues need not be explored.For example, it is almost certain that pharmacogenetics will result in increased response rates to several drug classes in selected population.However, pharmacogenetics does not obviate the issue of nonresponders.In contrast to adults, there are generally considered to be fewer evidence-based treatment options for HF in pediatric populations.Although pediatric HF is far less prevalent than adult HF (estimated at about 1:100,000), therapy for pediatric HF is considered an unmet need.In a recent review, Del Castillo et al. (2) summarized the currently available options for pediatric patients with HF, including several of those available to adults.These include inotropes such as dopamine, dobutamine, and epinephrine, with the standard caveats of increased heart rate and myocardial oxygen consumption.Also included are angiotensin-converting enzyme inhibitors and ARBs.