Published online May 1, 2006
PEDIATRICS Vol. 117 No. 5 May 2006, pp. 1864 (doi:10.1542/peds.2005-3189)
This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Related articles in Pediatrics
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Rein, J.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Rein, J.
Related Collections
Right arrow Office Practice

Therapeutic Nihilism in Duchenne Cardiomyopathy

Jeffrey Rein, MD, FAAP
El Rio Neighborhood Health Center
Tucson, AZ 85719

To the Editor.

The recent American Academy of Pediatrics clinical report on cardiovascular supervision in Duchenne muscular dystrophy1 was overly nihilistic. Advances in diagnostic and therapeutic interventions were dismissed or ignored. The authors call for early recognition of cardiac dysfunction and acknowledge the limitations of echocardiography in scoliotic patients but do not mention B-type natriuretic peptide. Assay of serum B-type natriuretic peptide is widely available and may identify patients with cardiac involvement even before symptoms develop.2,3 Several studies, including some cited in their report, suggest the possibility of significant benefit from both angiotensin-converting enzyme (ACE) inhibition and ß blockade in the treatment of Duchenne cardiomyopathy.4–6 There are no reports of significant unanticipated risk from these therapies.

Unfortunately, optimal studies have not been conducted and may never be. The toll of cardiac disease on patients with muscular dystrophy is high, however, and safe, rational, and apparently effective modalities for evaluating and treating these patients are readily available. We should not dismiss their use out of hand.

REFERENCES

  1. American Academy of Pediatrics, Section on Cardiology and Cardiac Surgery. Cardiovascular health supervision for individuals affected by Duchenne or Becker muscular dystrophy. Pediatrics. 2005;116 :1569 –1573[Abstract/Free Full Text]
  2. Mori K, Manabe T, Nii M, Hayabuchi Y, Kuroda Y, Tatara K. Plasma levels of natriuretic peptide and echocardiographic parameters in patients with Duchenne's progressive muscular dystrophy. Pediatr Cardiol. 2002;23 :160 –166[CrossRef][ISI][Medline]
  3. Kashiwagi S, Akaike M, Kawai H, Adachi K, Saito S. Estimation of cardiac function by plasma concentration of brain natriuretic peptide in patients with Duchenne muscular dystrophy [in Japanese]. Rinsho Shinkeigaku. 1996;36 :7 –11[Medline]
  4. Ishikawa Y, Bach JR, Ishikawa Y, Minami R. A management trial for Duchenne cardiomyopathy. Am J Phys Med Rehabil. 1995;74 :345 –350[ISI][Medline]
  5. Shaddy RE, Tani LY, Gidding SS, et al. Beta-blocker treatment of dilated cardiomyopathy with congestive heart failure in children: a multi-institutional experience. J Heart Lung Transplant. 1999;18 :269 –274[CrossRef][ISI][Medline]
  6. Ishikawa Y, Bach JR, Minami R. Cardioprotection for Duchenne's muscular dystrophy. Am Heart J. 1999;137 :895 –902[CrossRef][ISI][Medline]
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics

Related articles in Pediatrics:

Therapeutic Nihilism in Duchenne Cardiomyopathy: In Reply
Linda Cripe and Larry Markham
Pediatrics 2006 117: 1865. [Extract] [Full Text]  




This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Related articles in Pediatrics
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Rein, J.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Rein, J.
Related Collections
Right arrow Office Practice