Cardiac Evaluation before and after Oral Propranolol Treatment for Infantile Hemangiomas

Abstract

Background: Most recent clinical practice guidelines addressing the management of infantile hemangiomas (IHs) recommend oral propranolol, a non-selective beta-adrenergic antagonist, as first-line treatment. However, few reports have provided continuous follow-up data regarding cardiac evaluations. Methods: Sixty-four patients diagnosed with IHs and treated with oral propranolol before 2 years of age at the Department of Pediatrics, Kangbuk Samsung Hospital (Seoul, Republic of Korea), with regular examinations between 2017 and 2021, were included. Cardiac evaluations, including electrocardiography, Holter monitoring, chest X-ray, and echocardiography, were performed. Results: Sixty-four patients with IHs successfully underwent continuous follow-up cardiac evaluations. The median age at diagnosis was 2 weeks (1 day to 34.3 weeks). The median age at treatment initiation was 13.6 weeks (2.4-87.9 weeks), the mean longitudinal diameter of hemangioma at diagnosis was 2.8 ± 2.1 cm (0.3-12.0 cm), and the mean percentage of size decrease after 1 year of oral propranolol treatment was 71.8%. None of the 64 patients experienced severe adverse side effects during propranolol treatment. There was no statistically significant differences in echocardiographic function and electrocardiographic data after treatment. Conclusions: Propranolol treatment ≥6 months was effective and safe without significant cardiac toxicity in the treatment of patients with infantile hemangiomas.

Keywords: cardiac evaluations; infantile hemangiomas; propranolol.

Figure 1

Efficacy and safety assessments before and after oral propranolol treatment in hemangioma. Note: mo, month; Hx, history; BP, blood pressure; HR, heart rate; PE, physical examination; Lab, laboratory; CBC, complete blood count; PT, prothrombin time; aPTT, activated partial thromboplastin time; ECG, electrocardiogram; Echo, echocardiography; MSK, musculoskeletal; USG, ultrasonography; MRI, magnetic resonance imaging; CT, computed tomography.