Objective: 

Children with congenital heart disease (CHD) are at increased risk for attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to determine whether children with CHD and ADHD clinically treated with stimulant medication were at increased risk for changes in cardiovascular parameters or death compared with CHD-matched controls.

Methods: 

In this retrospective cohort study, patients with CHD + ADHD treated with stimulant medication (exposed group [EG]) were matched by CHD diagnosis and visit age to patients not on stimulants (nonexposed group [NEG]). Cardiovascular parameters (heart rate [HR] and systolic and diastolic blood pressure [SBP and DBP]) and electrocardiograms (ECGs) from medical records over 12 months were compared using mixed effects models.

Results: 

Cardiovascular parameters for 151 children with CHD (mean age 8 ± 4 years) were evaluated (N = 46 EG and N = 105 NEG). Stimulant medication use was not associated with sudden cardiac death. HR and SBP did not significantly change over time in the EG and remained similar between groups. EG children had higher DBP compared with NEG children over time (p = 0.001). Group × time interactions for HR, SBP, and DBP were not different between the EG and NEG. QTc was not significantly different between the EG and NEG (447 ms vs 439 ms, p = 0.23). EG children demonstrated improvement in ADHD symptoms.

Conclusion: 

Stimulant medication use in children with CHD was not associated with clinically significant changes in cardiovascular parameters compared with controls. Stimulants should be considered for ADHD treatment in children with CHD when prescribed with appropriate monitoring and coordination with the cardiologist.

中文翻译：

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先天性心脏病和注意力缺陷/多动症儿童的兴奋剂药物治疗：心血管结局

客观的： 

患有先天性心脏病(CHD)的儿童患注意力缺陷/多动障碍(ADHD) 的风险增加。本研究的目的是确定与 CHD 匹配对照相比，接受兴奋剂药物临床治疗的 CHD 和 ADHD 儿童心血管参数变化或死亡的风险是否增加。

方法： 

在这项回顾性队列研究中，使用兴奋剂药物治疗的 CHD + ADHD 患者（暴露组 [EG]）根据 CHD 诊断和就诊年龄与未服用兴奋剂的患者（非暴露组 [NEG]）进行匹配。使用混合效应模型对 12 个月以上医疗记录中的心血管参数（心率 [HR] 以及收缩压和舒张压 [SBP 和 DBP]）和心电图 (ECG) 进行比较。

结果： 

对 151 名 CHD 儿童（平均年龄 8 ± 4 岁）的心血管参数进行了评估（N = 46 EG 和 N = 105 NEG）。兴奋剂药物的使用与心源性猝死无关。EG 中的 HR 和 SBP 没有随时间发生显着变化，并且组间保持相似。随着时间的推移，EG 儿童的 DBP 高于 NEG 儿童 ( p = 0.001)。EG 和 NEG 之间 HR、SBP 和 DBP 的组 × 时间交互作用没有差异。EG 和 NEG 之间的 QTc 没有显着差异（447 毫秒 vs 439 毫秒，p = 0.23）。EG 儿童的 ADHD 症状有所改善。

结论： 

与对照组相比，CHD 儿童使用兴奋剂药物与心血管参数的临床显着变化无关。在与心脏病专家进行适当监测和协调的情况下，应考虑使用兴奋剂治疗患有先天性心脏病的儿童。