Cardiac remodelling and myocardial contractility in patients with congestive heart failure treated with furosemide and enalapril.
Eleven patients with congestive heart failure class II-IV (NYHA) caused by ischemic heart disease were studied before and three months after adding enalapril to their treatment with furosemide. After an infarction the heart dilates gradually, mainly as a result of slippage of myocardial fiber bundles. It is known that the addition of an ACE-inhibitor to the medical treatment unloads the heart and gradually, within a period of 3 months, reduces heart size. Objectives of this study were to demonstrate remodelling by recording diastolic pressure-volume relations before and after treatment. The study addresses the question of whether regression of dilation, induced by the ACE-inhibitor treatment, improves the oxygen supply-demand ratio and, as a result, the contractility of the heart muscle. Treatment resulted in a reduction of vascular resistance (1479 to 1182 dyn.s.cm-5, p less than 0.05) and of the left ventricular end-diastolic (130 to 108 ml per m2 body surface area, p less than 0.05) and end-systolic (102 to 81 ml per m2 body surface area, p less than 0.01) volume index. The slope of the end-systolic pressure-volume relation, measured using vena cava occlusion and beat-to-beat recording of pressure and volume loops, remained unchanged. Indices of oxygen-supply demand ratio such as a drop of ejection fraction during exercise and parameters of active diastolic relaxation also did not change. Addition of an ACE-inhibitor induces regression of ventricular dilation, but no indications were found that it improves the condition of the cardiac muscle.
Baur
L H
LH
Department of Cardiology, University Hospital Leiden, The Netherlands.
Schipperheyn
J J
JJ
Bann
J
J
van der Laarse
A
A
van der Wall
E E
EE
van Dijk
A D
AD
Buis
B
B
Manger Cats
V
V
Bruschke
A V
AV
D000368:Aged; D000804:Angiotensin II / Q000097:blood; D006332:Cardiomegaly / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000008:administration & dosage*; D005665:Furosemide / Q000008:administration & dosage*; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects
D000804:Angiotensin II; D004656:Enalapril; D005665:Furosemide