[Acute effect of enoximone and captopril in patients with heart failure]

The acute effects of enoximone (E) and captopril (C) were compared in a single-blind, randomized, cross-over trial in 10 patients (P) (nine with dilative cardiomyopathy, one with coronary heart disease) with heart failure (NYHA Class III: 6P and Class IV:4P). Cardiac index (Cl, 1/min.nm(-2), mean pulmonary artery pressure (PAM, mmHg), and pulmonary capillary wedge pressure (PC, mmHg) were measured at baseline and 15, 30, and 60 min after 0.1 mg/kg C and 0.75 mg/kg E, respectively, followed by measurements at 15, 30, 60, 180, and 300 min after 0.2 mg/kg C and 1,5 mg/kg E, respectively.

Cl was unchanged 60 min after 0.1 mg/kg C, increased 60 min after 0.2 mg/kg C by 7.7% from 2.1 +/- 0.5 to 2.4 +/- 0.5 (p = 0,001), and was unchanged after 5 h. Cl increased 60 min after 0.75 mg/kg E by 32.5% from 2.1 +/- 0.5 to 2.9 +/- 0.4 (p = 0.001), 60 min after 1,5 mg/kg E by 59% to 3.3 +/- 0.6 (p = 0,001), and after 5 h by 19% to 2.5 +/- 0.4 (p = 0.01). PAM was unchanged 60 min after 0.1 mg/kg C, decreased 60 min after 0.2 mg/kg C by 10% from 35.7 +/- 11 to 31.7 +/- 10, and was unchanged after 5 h. PAM decreased 60 min after 0.75 mg/kg E by 13% from 35 +/- 9 to 31 +/- 10 (p = 0.01), 60 min after 1.5 mg/kg E by 19% from 35 +/- 9 to 27 +/- 9 (p = 0.001), and was unchanged after 5 h. PC decreased 60 min after 0.1 mg/kg C by 23% from 24 +/- 8 to 19 +/- 9 (p = 0.05) and was unchanged 60 min und 5 h after 0.2 mg/kg C. PC decreased 60 min after 0.75 mg/kg E by 35% from 25 +/- 6 to 17 +/- 8 (p = 0,01) and 60 min after 1.5 mg/kg E by 47% to 14 +/- 8 (p = 0,001) and was unchanged after 5 h.

The clinical trial showed that in P with chronic heart failure (NYHA III and IV) the acute increase of Cl and decrease of PC is higher after E than after C. The improvement of hemodynamics lasts longer after i.v. E than i.v.C.