Severe DCM in infants is associated with progressive LV dysfunction and high mortality. A study published in the International Journal of Cardiology evaluated whether prophylactic PAB could improve clinical outcomes when added to GDMT in children with marked LV dilation.

The retrospective cohort included 67 children with severe DCM. Of these, 21 received PAB and 46 received GDMT alone. Propensity score matching generated 11 matched pairs based on pre-treatment variables, including LV end-diastolic diameter (LVEDD) and Ross functional class. Study outcomes included survival and echocardiographic measures of LV remodeling at 6 and 12 months.

In the matched cohort, survival was 90.9% with PAB compared with 63.6% with GDMT alone. At 6 months, the LVEDD Z-score was 1.4 ± 3.0 with PAB versus 6.6 ± 5.1 with GDMT (p = 0.03). By 12 months, left ventricular ejection fraction (LVEF) improved to 51.1 ± 8.2% with PAB, compared with 37.8 ± 9.5% with GDMT (p < 0.05).These findings indicate more favorable LV remodeling with PAB.

The results suggest that PAB may serve as an adjunctive therapeutic option in infants with severe DCM who do not demonstrate adequate response to GDMT.