Çocukluk çağı dilate kardiyomiyopati olgularında ibopamin tedavisinin etkinliğinin değerlendirilmesi

Evaluation of the efficacy of ibopamine in patients with dilated cardiomyopathy during childhood

Mithat KUŞKAYA, Ali Burak ERDİNÇ, Gökmen BİLGİLİ, Türkay SARITAŞ, Şükrü CANGAR, Timur MEŞE, Vedide TAVLI

Özet

Çocuklarda dilate kardiyomiyopatiye bağlı kronik konjestif kalp yetersizliğinde standart antikonjestif tedavi digoksin, diüretik ve anjiotensin dönüştürücü enzim inhibitörlerinin kombinasyonunu içerir. Akut dönemdeki olgulara intravenöz yolla inotropik ajanlar kullanılmaktadır. Oral dopamin agonisti olan ibopamin erişkinlerde kronik kalp yetersizliği tedavisinde en çok araştırılıp yararlılığı bildirilen inotropik ilaçtır. Bu çalışmada daha evvel çocukluk çağında denenmemiş olan ibopamini dilate kardiyomiyopatili olgularda üçlü güncel tedaviye ekleyerek klinik ve ekokardiyografi bulguları eşliğinde etkinliğini araştırdık. Bu amaçla halen üçlü tedavi verilen dilate kardiyomiyopatili 10 olgu rasgele eşit iki gruba ayrılarak birinci gruba standart tedaviyle devam edilip, ikinciye ibopamin (2 mg/ kg/gün) eklendi. Sekizinci hafta sonunda ibopamin grubunda kalp yetersizliği bulguları orta veya ağır dereceden hafif veya orta dereceye gerilerken, standart tedavi grubunda klinik bulgularda değişiklik saptanmadı, izlem sonunda ibopamin grubunda ejeksiyon fraksiyonu ve fraksiyonel kısalma indekslerinde anlamlı artış olduğunu (p

Abstract

The standart antıcongestive treatment of chronic congestive heart failure due to dilated cardiomyopathy during childhood includes the combination of digoxin, a diuretic, and an angiotensin-converting enzyme inhibitor, Inotropic agents are used intravenously in acutely ili patients. Ibopamine, an oral dopamine agonist, is the most widely investigated inotropic agent in the treatment of chronic heart failure in adult patients and is reported to be useful. in this study, we combined ibopamine, which has not been tried before during childhood to the current therapeutic regimen of three drugs, and investigated its efficacy with the accompanying dinical and echocardiographic findings. For this purpose, 10 children with dilated cardiomyopathy were randomly divided into two groups, and five of them continued to have the standart combination and the remaining five were given ibopamine (2 mg/kg/day) additionally. Moderately or severely symptomatic patients were mildly ör moderately symptomatic in the ibopamine group at the end of eight weeks, however, no significant changes were observed in the standart-therapy group. We observed significant increases in the ejection fraction and the fractional shortening of the ibopamine group (p< 0.05), and that the percentage of change in these increases was significantly higher than the standart-therapy group ( p=0.001 and p< 0.01, respectively) at the end of the follow-up. We did not experience significant side effects due to ibopamine treatment. it is concluded that the addition of ibopamine to the standart anticongestive triple drug combination in moderate to severely symptomatic children with dilated cardiomyopathy resulted in an increase in their functional capacities in a short-term period. Hovvever, studies in larger series with a longer follow-up period are required to confirm these findings.