{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:19:27Z","timestamp":1787775567503,"version":"build-2784847793"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n                    <jats:title>Aims :<\/jats:title>\n                    <jats:p>The utility of beta-blocker therapy in infants with heart failure (HF) due to significant left-to-right shunt lesions is not known. The study aimed to assess the efficacy and safety of propranolol in infants with HF due to moderate-to-large ventricular septal defect (VSD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods :<\/jats:title>\n                    <jats:p>\n                      The prospective randomized trial included 80 infants with HF and moderate-to-large VSD, randomly allocated to receive either conventional therapy alone (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 40) or propranolol plus conventional therapy (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 40). The primary endpoint was a composite of all-cause mortality, hospitalization for HF and\/or chest infection, and referral for surgery. The secondary clinical outcomes were the individual components of the composite endpoint. In addition, the patients were followed up to detect safety outcomes, for example, bronchospasm, bradyarrhythmia, and worsening HF symptoms.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results :<\/jats:title>\n                    <jats:p>\n                      The addition of propranolol therapy to the conventional medications did not result in significant improvement in the primary composite endpoint (32.50% vs. 52.50%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.07). There was a trend toward improvement, but the study is underpowered for this important question. However, propranolol therapy significantly decreased the risk of hospitalization (12.50% vs. 32.50%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.03) and worsening of Ross HF class (5.41% vs. 28.21%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.01) as compared to conventional therapy (estimated number needed to treat = 5). Propranolol did not result in any significant safety concerns in these infants except bronchospasm in an infant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions :<\/jats:title>\n                    <jats:p>Propranolol therapy in infants with significant left-to-right shunt may prevent worsening in HF symptoms and hospitalization and is well tolerated. However, it does not reduce mortality or need for surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/apc.apc_94_21","type":"journal-article","created":{"date-parts":[[2021,8,11]],"date-time":"2021-08-11T08:13:37Z","timestamp":1628669617000},"page":"331-340","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":11,"title":["Efficacy and safety of propranolol in infants with heart failure due to moderate-to-large ventricular septal defect (VSD-PHF study) \u2013 A prospective randomized trial"],"prefix":"10.4103","volume":"14","author":[{"given":"Sivasubramanian","family":"Ramakrishnan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirmal","family":"Ghati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramandeep Singh","family":"Ahuja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinjal Niranjan","family":"Bhatt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hem Chandra","family":"Sati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Saxena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shyam Sunder","family":"Kothari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-11-20240901","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1016\/0002-9149(87)90380-8","article-title":"Spontaneous closure of uncomplicated ventricular septal defect","volume":"60","author":"Moe","year":"1987","journal-title":"Am J Cardiol"},{"key":"R2-11-20240901","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1161\/CIRCULATIONAHA.109.927988","article-title":"Enalapril in infants with single ventricle: Results of a multicenter randomized trial","volume":"122","author":"Hsu","year":"2010","journal-title":"Circulation"},{"key":"R3-11-20240901","doi-asserted-by":"crossref","first-page":"149","DOI":"10.4103\/0974-2069.58317","article-title":"Digoxin in management of heart failure in children: Should it be continued or relegated to the history books?","volume":"2","author":"Jain","year":"2009","journal-title":"Ann Pediatr Cardiol"},{"key":"R4-11-20240901","doi-asserted-by":"crossref","first-page":"e000365","DOI":"10.1136\/bmjpo-2018-000365","article-title":"Pharmacotherapeutic management of paediatric heart failure and ACE-I use patterns: A European survey","volume":"3","author":"Castro D\u00edez","year":"2019","journal-title":"BMJ Paediatr Open"},{"key":"R5-11-20240901","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1136\/adc.70.1.35","article-title":"Efficacy and dosage of enalapril in congenital and acquired heart disease","volume":"70","author":"Leversha","year":"1994","journal-title":"Arch Dis Child"},{"key":"R6-11-20240901","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1067\/mhj.2002.121265","article-title":"Carvedilol therapy in pediatric patients with congestive heart failure: A study investigating clinical and pharmacokinetic parameters","volume":"143","author":"L\u00e4er","year":"2002","journal-title":"Am Heart J"},{"key":"R7-11-20240901","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1067\/mpd.2001.113045","article-title":"Carvedilol as therapy in pediatric heart failure: An initial multicenter experience","volume":"138","author":"Bruns","year":"2001","journal-title":"J Pediatr"},{"key":"R8-11-20240901","doi-asserted-by":"crossref","first-page":"2034","DOI":"10.1016\/S0735-1097(02)02570-6","article-title":"Delisting of infants and children from the heart transplantation waiting list after carvedilol treatment","volume":"40","author":"Azeka","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"R9-11-20240901","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1001\/jama.298.10.1171","article-title":"Carvedilol for children and adolescents with heart failure: A randomized controlled trial","volume":"298","author":"Shaddy","year":"2007","journal-title":"JAMA"},{"key":"R10-11-20240901","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1007\/s10741-019-09797-y","article-title":"Levels of angiotensin peptides in healthy and cardiovascular\/renal-diseased paediatric population-an investigative review","volume":"24","author":"Suessenbach","year":"2019","journal-title":"Heart Fail Rev"},{"key":"R11-11-20240901","doi-asserted-by":"crossref","first-page":"2368","DOI":"10.1161\/01.CIR.0000101681.27911.FA","article-title":"Stratification of pediatric heart failure on the basis of neurohormonal and cardiac autonomic nervous activities in patients with congenital heart disease","volume":"108","author":"Ohuchi","year":"2003","journal-title":"Circulation"},{"key":"R12-11-20240901","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/S0167-5273(01)00413-2","article-title":"Propranolol treatment of congestive heart failure in infants with congenital heart disease: The CHF-PRO-INFANT Trial. Congestive heart failure in infants treated with propanol","volume":"79","author":"Buchhorn","year":"2001","journal-title":"Int J Cardiol"},{"key":"R13-11-20240901","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/S0167-5273(00)00384-3","article-title":"Effectiveness of low dose captopril versus propranolol therapy in infants with severe congestive failure due to left-to-right shunts","volume":"76","author":"Buchhorn","year":"2000","journal-title":"Int J Cardiol"},{"key":"R14-11-20240901","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1016\/S0002-9149(98)00175-1","article-title":"Beta-blocker therapy of severe congestive heart failure in infants with left to right shunts","volume":"81","author":"Buchhorn","year":"1998","journal-title":"Am J Cardiol"},{"key":"R15-11-20240901","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1016\/j.athoracsur.2012.05.135","article-title":"Protecting the infant brain during cardiac surgery: A systematic review","volume":"94","author":"Hirsch","year":"2012","journal-title":"Ann Thorac Surg"},{"key":"R16-11-20240901","doi-asserted-by":"crossref","first-page":"254","DOI":"10.4103\/apc.APC_32_19","article-title":"Indian guidelines for indications and timing of intervention for common congenital heart diseases: Revised and updated consensus statement of the Working group on management of congenital heart diseases","volume":"12","author":"Saxena","year":"2019","journal-title":"Ann Pediatr Cardiol"},{"key":"R17-11-20240901","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1542\/pir.32.3.100","article-title":"Failure to thrive: Current clinical concepts","volume":"32","author":"Jaffe","year":"2011","journal-title":"Pediatr Rev"},{"key":"R18-11-20240901","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/0002-9149(87)91118-0","article-title":"Plasma norepinephrine levels in infants and children with congestive heart failure","volume":"59","author":"Ross","year":"1987","journal-title":"Am J Cardiol"},{"key":"R20-11-20240901","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1001\/jama.1957.02980080017003","article-title":"Ventricular septal defects; their natural transformation into the cyanotic or noncyanotic type of tetralogy of Fallot","volume":"164","author":"Gasul","year":"1957","journal-title":"J Am Med Assoc"},{"key":"R21-11-20240901","doi-asserted-by":"crossref","first-page":"99","DOI":"10.2174\/1573403X12666151119164525","article-title":"The pathophysiology of heart failure in children: The basics","volume":"12","author":"Knudson","year":"2016","journal-title":"Curr Cardiol Rev"},{"key":"R22-11-20240901","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1161\/CIRCULATIONAHA.107.714402","article-title":"Pathophysiology of congenital heart disease in the adult: Part I: Shunt lesions","volume":"117","author":"Sommer","year":"2008","journal-title":"Circulation"},{"key":"R23-11-20240901","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1161\/CIRCRESAHA.116.308996","article-title":"Heart failure in pediatric patients with congenital heart disease","volume":"120","author":"Hinton","year":"2017","journal-title":"Circ Res"},{"key":"R24-11-20240901","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1093\/eurheartj\/ehs229","article-title":"Beta-adrenergic adaptation in paediatric idiopathic dilated cardiomyopathy","volume":"35","author":"Miyamoto","year":"2014","journal-title":"Eur Heart J"},{"key":"R25-11-20240901","doi-asserted-by":"crossref","first-page":"45","DOI":"10.2217\/phe.09.65","article-title":"Role of \u03b2-blocker therapy in pediatric heart failure","volume":"4","author":"Patel","year":"2010","journal-title":"Ped Health"},{"key":"R26-11-20240901","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.jacc.2009.03.061","article-title":"Sympathetic nervous system activation in human heart failure: Clinical implications of an updated model","volume":"54","author":"Floras","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"R27-11-20240901","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1006\/jmcc.2001.1358","article-title":"Altered beta-adrenergic receptor gene regulation and signaling in chronic heart failure","volume":"33","author":"Port","year":"2001","journal-title":"J Mol Cell Cardiol"},{"key":"R28-11-20240901","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1093\/eurheartj\/ehs402","article-title":"Beta-adrenergic adaptation in idiopathic dilated cardiomyopathy: Differences between children and adults","volume":"35","author":"Lipshultz","year":"2014","journal-title":"Eur Heart J"},{"key":"R29-11-20240901","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1056\/NEJM199908193410806","article-title":"Hormones and hemodynamics in heart failure","volume":"341","author":"Schrier","year":"1999","journal-title":"N Engl J Med"},{"key":"R30-11-20240901","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/S0002-8703(99)70009-8","article-title":"Predictors of decreased renal function in patients with heart failure during angiotensin-converting enzyme inhibitor therapy: Results from the studies of left ventricular dysfunction (SOLVD)","volume":"138","author":"Knight","year":"1999","journal-title":"Am Heart J"},{"key":"R31-11-20240901","doi-asserted-by":"crossref","first-page":"eaaw6419","DOI":"10.1126\/scitranslmed.aaw6419","article-title":"Control of cytokinesis by \u03b2-adrenergic receptors indicates an approach for regulating cardiomyocyte endowment","volume":"11","author":"Liu","year":"2019","journal-title":"Sci Transl Med"},{"key":"R32-11-20240901","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.cell.2012.06.037","article-title":"Regulation of the Hippo-YAP pathway by G-protein-coupled receptor signaling","volume":"150","author":"Yu","year":"2012","journal-title":"Cell"},{"key":"R34-11-20240901","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1056\/NEJM200105313442201","article-title":"Effect of carvedilol on survival in severe chronic heart failure","volume":"344","author":"Packer","year":"2001","journal-title":"N Engl J Med"},{"key":"R36-11-20240901","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1161\/CIRCULATIONAHA.113.003615","article-title":"Update on pharmacological heart failure therapies in children: Do adult medications work in children and if not, why not?","volume":"129","author":"Rossano","year":"2014","journal-title":"Circulation"},{"key":"R37-11-20240901","first-page":"Cd007037","article-title":"Beta-blockers for congestive heart failure in children","volume":"7","author":"Alabed","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"R38-11-20240901","first-page":"105","article-title":"Propranolol in infants with ventricular septal defect with heart failure (VSD-PHF Study)","volume":"6","author":"Ahuja","year":"2013","journal-title":"Ann Pediatr Cardiol"},{"key":"R39-11-20240901","first-page":"87","article-title":"Carvedilol in pediatric left to right shunt congestive heart failure","volume":"7","author":"Ontoseno","year":"2014","journal-title":"Ann Pediatr Cardiol"},{"key":"R40-11-20240901","first-page":"310","article-title":"Drug therapy of cardiac diseases in children","volume":"46","author":"Saxena","year":"2009","journal-title":"Indian Pediatr"},{"key":"R41-11-20240901","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1007\/s00246-012-0306-8","article-title":"The Ross classification for heart failure in children after 25 years: A review and an age-stratified revision","volume":"33","author":"Ross","year":"2012","journal-title":"Pediatr Cardiol"}],"container-title":["Annals of Pediatric Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/apc.APC_94_21","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:32:19Z","timestamp":1787772739000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/apc.APC_94_21"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7]]},"references-count":38,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.4103\/apc.apc_94_21","relation":{},"ISSN":["0974-2069"],"issn-type":[{"value":"0974-2069","type":"print"}],"subject":[],"published":{"date-parts":[[2021,7]]}}}