Angiotensin converting enzyme inhibitors in bone marrow transplant recipients with depressed left ventricular function.
Pre-existing left ventricular dysfunction in patients undergoing induction therapy with cyclophosphamide prior to bone marrow transplantation (BMT) has resulted in overt heart failure in a large number of patients. This fact excludes the majority of such patients from consideration for BMT at many centers. We sought to determine if prophylactic treatment with the angiotensin converting enzyme inhibitor enalapril prevents this deterioration in pre-existing left ventricular dysfunction. We treated six consecutive patients with initial left ventricular ejection fractions (LVEF) by radionuclide gated blood pool imaging (RGBP) of < 50% (42 +/- 7%) with enalapril 5 mg orally twice per day started 48 h prior to induction therapy and continued throughout the follow-up period. Serial RGBP imaging demonstrated an increase in LVEF in all patients to 54 +/- 6% (P < 0.005). No patient experienced clinical deterioration during a follow-up period of 18 +/- 11 months. We conclude that prophylactic treatment with enalapril may prevent deterioration in pre-existing mild left ventricular dysfunction during BMT.
Kakavas
P W
PW
Section of Cardiology, Rush Medical College, Rush Presbyterian St. Luke's Medical Center, Chicago, IL 60612-3833, USA.
Ghalie
R
R
Parrillo
J E
JE
Kaizer
H
H
Barron
J T
JT
D000293:Adolescent; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000009:adverse effects; D016026:Bone Marrow Transplantation; D001943:Breast Neoplasms / Q000628:therapy; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000009:adverse effects; D003630:Daunorubicin / Q000009:adverse effects; D004317:Doxorubicin / Q000009:adverse effects; D018618:Echocardiography, Doppler, Color; D004656:Enalapril / Q000627:therapeutic use*; D005260:Female; D015637:Gated Blood-Pool Imaging; D006333:Heart Failure / Q000517:prevention & control*; D006801:Humans; D015255:Idarubicin / Q000009:adverse effects; D007938:Leukemia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000188:drug therapy; D011878:Radiotherapy / Q000009:adverse effects; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016277:Ventricular Function, Left
D000806:Angiotensin-Converting Enzyme Inhibitors; D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D004656:Enalapril; D004317:Doxorubicin; D003520:Cyclophosphamide; D015255:Idarubicin; D003630:Daunorubicin