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Beta-adrenergic adaptation in paediatric idiopathic dilated cardiomyopathy
European Heart Journal, 08/08/2012
Exclusive author commentary
Miyamoto SD et al. – There is a different adaptation of (beta)–AR and adrenergic signalling pathways in children with heart failure (HF) compared with adults. The results begin to address the disparities in cardiovascular research specific to children and suggest that age–related differences in adaptation could influence the response to therapy. These findings could lead to a paradigm shift in the contemporary management of children with HF.
Brian L. Stauffer (08/08/2012) comments:
While outcomes in response to changing medical therapy from the dig/diuretic era to the ACEI/Beta Blocker era have improved in adults with heart failure this has not been the case in children with the disease. Most pediatric guidelines for the treatment of heart failure are based on adult evidence and are expert consensus recommendations. These data suggest that there are fundimental myocellular differences in the way the pediatric heart adapts to heart failure and that there is a need for unique treatment strategies in these children. Additional work will be necessary to identify these pediatric specific treatment paradigms.