January 1, 2010Open Access

Carvedilol can Prevent Cardiac Events in Duchenne Muscular Dystrophy

TMTsuyoshi MatsumuraToneyama National Hospital TTTakuhisa TamuraNational Hospital Organization SKSatoshi KuruNational Institute of Technology, Suzuka College

Structured PICO

Does carvedilol prevent cardiac events in patients with Duchenne muscular dystrophy?

Population

54 patients with Duchenne muscular dystrophy (DMD) without complaints associated with cardiac dysfunction at enrollment. Patients with LVEF <50% received ACE inhibitors or ARBs.

Intervention

Carvedilol (mean maintenance dose 7.85+/-2.80 mg/day), started at a low dose (0.3125 mg or 0.625 mg twice daily) and gradually increased, added to standard therapy.

Comparator

No carvedilol (non BB group), receiving standard therapy (ACE inhibitors or ARBs if LVEF <50%).

Outcome

Composite of all-cause death, deterioration of heart failure requiring intravenous catecholamine, phosphodiesterase III inhibitor or diuretics more than 15 days, and severe arrhythmia requiring cardioversion or intravenous antiarrhythmic agents more than 15 days.composite

Carvedilol is relatively safe and significantly reduces the risk of cardiac events in patients with Duchenne muscular dystrophy when added to standard therapy.

Abstract

OBJECTIVE: Heart failure is one of the most serious complications in Duchenne muscular dystrophy (DMD). Beta-blocker medication is known to improve the prognosis of chronic heart failure of adults, but its efficacy and safety for DMD patients has not been fully assessed. Thus we conducted a multicenter open trial. METHODS: Fifty-four DMD patients participated; 41 received carvedilol (BB group) and 13 did not (non BB group). All patients with an ejection fraction of less than 50% received angiotensin-converting enzyme inhibitor. Then, patients in BB group were started on carvedilol. The mean maintenance dose of carvedilol in BB group was 7.85+/-2.80 mg/day. Clinical signs and cardiac function were monitored regularly and statistical analysis was done. RESULTS: The survival rate free from primary endpoints (death, deterioration of heart failure and severe arrhythmia) was higher in the BB group. The survival rate free from all-cause death was also higher in the BB group, although not significantly higher. Patients with primary endpoints received lower maintenance doses of carvedilol and presented higher mean heart rates (HR) during the observation period. In the BB group, mean HR at enrollment and the reduction of mean HR were correlated with the change of ejection fraction. Although serious adverse events were rare during the introduction of carvedilol, patients with advanced cardiac dysfunction required a longer period for up-titration and frequently presented with minor complaints. CONCLUSION: The present study suggests that carvedilol is relatively safe and can prevent cardiac events even in patients with DMD.

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