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Clinical studies of enalapril treatment for patients with severe congestive heart failure
T Sato1, M Takeshi, A Yamamoto
12nd Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
Insights
Enalapril significantly improved severe heart failure symptoms and cardiac function in patients. This treatment demonstrated neurohormonal benefits and is recommended for severe congestive heart failure (CHF).
Area of Science:
- Cardiology
- Pharmacology
Background:
- Severe heart failure (CHF) significantly impacts patient prognosis and quality of life.
- Current treatments aim to improve symptoms, cardiac function, and neurohormonal balance.
Purpose of the Study:
- To evaluate the clinical efficacy of enalapril in patients with severe heart failure.
- To assess the impact of enalapril on cardiac function, hemodynamics, and neurohormonal markers.
Main Methods:
- A study involving 21 patients with severe heart failure receiving enalapril maintenance therapy.
- Comparison of clinical parameters (NYHA class, Killip's class, CTR), cardiac function (echocardiography, radionuclide angiography), and neurohormonal markers (plasma renin activity, aldosterone, norepinephrine) before and after treatment.
- Hemodynamic responses and drug concentrations were monitored.
Main Results:
- Significant improvements observed in NYHA functional class, Killip's class, and cardiothoracic ratio (CTR).
- Left ventricular (LV) fractional shortening and ejection fraction increased significantly; ventricular tachycardia frequency showed a decreasing trend.
- Hemodynamic assessment revealed reduced systemic vascular resistance, lower mean blood pressure, and increased cardiac index. No significant change in serum digoxin concentration indicated no pharmacokinetic interaction.
Conclusions:
- Enalapril is effective in improving clinical status, cardiac function, and hemodynamics in patients with severe heart failure.
- The drug may offer neurohormonal benefits, particularly indicated by plasma norepinephrine levels.
- Enalapril is recommended for the treatment of severe congestive heart failure (CHF).
Abstract:
The clinical efficacy of enalapril was investigated in 21 patients with severe heart failure. For each subject, the following parameters were compared before and one month after enalapril maintenance treatment. NYHA functional class, Killip's class, cardiothoracic ratio (CTR), left ventricular (LV) function estimated by echocardiography and gated equilibrium radionuclide angiography, Holter ECG recordings, serum digoxin concentration (SDC), plasma remin activity, plasma aldosterone concentration, plasma norepinephrine concentration (PNE), etc. Short- and long-term hemodynamic responses to enalapril were also studied, with simultaneous measurement of enalapril concentration by radioimmunoassay. After maintenance therapy, patients showed a significant improvement as judged by NYHA functional class, Killip's class, and CTR. The LV fractional shortening and the ejection fraction significantly increased. The frequency of ventricular tachycardia showed a significant tendency to decrease after the therapy. The SDCs were unchanged, which indicates no pharmacokinetic drug interaction between digoxin and enalapril. Hemodynamic assessment showed a reduction in systemic vascular resistance, a reduction in mean blood pressure, and an increase in the cardiac index. No major side effects were observed during the study period. According to a multivariate analysis, the coefficient of determination of PNE was the highest for the final global improvement rating. This may reflect the neurohormonal improvement of congestive heart failure by enalapril therapy. In conclusion, enalapril is recommended for treating patients with severe CHF.