Long-term captopril therapy in congestive heart failure: serial hemodynamic and echocardiographic changes.
Ten patients with refractory congestive heart failure (CHF) were followed serially for systemic hemodynamic (radionuclide techniques) and M-mode echocardiographic changes during long-term captopril therapy with optimum doses. After 1 week of maintenance captopril therapy, all patients were clinically improved. This was associated with a significant (p less than 0.05) reduction of total blood volume (-6 +/- 2% N), mean blood pressure (-9 +/- 3 mm Hg), and peak systolic left ventricular wall stress (-50 +/- 19 X 10(3) dynes/cm2). At the end of 2 months of maintained therapy, mean blood pressure reduction was -12 +/- 4 mm Hg (p less than 0.05); further hemodynamic improvement was manifested by a significant shortening of pulmonary mean transit time (-3.7 +2- 1.33 seconds, p less than 0.05). Echocardiographic data revealed an increase in end-diastolic septal wall thickness (+0.13 +/- 0.05, p less than 0.05) and left ventricular posterior wall thickness (+0.13 +/- 0.03, p less than 0.05), and further reduction in peak systolic stress (-84 +/- 23 X 10(3) dynes/cm2, p less than 0.05). The present study indicates the importance of measuring peak systolic wall stress in the follow-up of CHF patients. Moreover, we found that for functional circulatory evaluation during vasodilator therapy, the radionuclide first-pass methods were more helpful than both M-mode echocardiography and radionuclide gated blood pool techniques.
D000328:Adult; D000368:Aged; D002216:Captopril / Q000008:administration & dosage / Q000627:therapeutic use*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011392:Proline / Q000031:analogs & derivatives*
D011392:Proline; D002216:Captopril