Among patients with transfusion‑dependent thalassemia who had iron overload cardiomyopathy, carvedilol treatment improved left ventricular diastolic function. The findings were published in the Annals of Pediatric Cardiology.
Carvedilol is a nonselective beta-blocker with antioxidant properties. The investigators sought to establish the efficacy of carvedilol treatment in patients with transfusion‑dependent thalassemia who had left ventricular diastolic dysfunction without systolic dysfunction.
Between January 2014 and December 2016, a total of 18 patients with transfusion‑dependent thalassemia who had left ventricular diastolic dysfunction and normal left ventricular systolic function were enrolled in the study. The median age was 19 years (range, 13-25). All patients were administered carvedilol, with a target dose of 0.8 mg/kg/day. Treatment was continued for 6 months. Cardiac function (primary outcome) and iron levels were evaluated by echocardiography and magnetic resonance imaging (MRI) at 0, 3, and 6 months. Safety was also assessed.
At baseline, left ventricular diastolic dysfunction was grade 3/severe in 4 patients (22%) and grade 2 in 14 patients (77%). After 3 months of treatment, the grade of left ventricular diastolic dysfunction had improved to 11 patients (61%) with grade 2 and 1 patient (5%) with grade 1, while 6 patients (33%) had normal function (P <.0001). After 6 months of treatment, 12 patients (66%) had attained normal function (P <.0001); 5 patients (27%) and 1 patient (5%) had grade 2 and grade 1 dysfunction, respectively.
Compared to baseline measurements, doppler parameters were significantly lower at 3 months and 6 months after treatment; these included pulmonary vein atrial reversal velocity, pulmonary vein atrial reversal duration, and the difference of pulmonary vein atrial reversal and the mitral valve atrial contraction wave duration (P <.05 for all). The levels of serum ferritin and cardiac T2* were not significantly different after treatment relative to baseline levels.
Treatment with carvedilol was well tolerated at the target dose. No adverse effects were reported.
“The encouraging results from the study show that a double‑blinded randomized controlled trial of a large number of patients with transfusion‑dependent thalassemia is warranted,” the authors concluded.
Silvilairat S, Charoenkwan P, Saekho S, Tantiworawit A, Chattipakorn N. Carvedilol improves left ventricular diastolic dysfunction in patients with transfusion-dependent thalassemia. Ann Pediatr Cardiol. 2021;14(2):152-158. doi:10.4103/apc.APC_63_20