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Acute hemodynamic effects of captopril in children with a congestive or restrictive cardiomyopathy
A R Bengur1, R H Beekman, A P Rocchini
1Department of Pediatrics, University of Michigan, Ann Arbor 48109-0204.
Insights
Captopril improved cardiac output and reduced vascular resistance in children with congestive cardiomyopathy. However, it caused hypotension and did not improve cardiac output in those with restrictive cardiomyopathy.
Area of Science:
- Pediatric Cardiology
- Pharmacology
- Cardiovascular Research
Background:
- Cardiomyopathy in children presents significant challenges.
- Understanding the acute hemodynamic effects of medications like captopril is crucial for pediatric cardiovascular care.
Purpose of the Study:
- To evaluate the acute hemodynamic effects of captopril in pediatric patients with cardiomyopathy.
- To differentiate the drug's impact on congestive versus restrictive cardiomyopathy.
Main Methods:
- Cardiac catheterization was performed on 16 children (0.3-18 years) with cardiomyopathy.
- Hemodynamic parameters including blood pressure and cardiac output were measured before and after oral administration of captopril (0.5 mg/kg).
Main Results:
- In congestive cardiomyopathy, captopril increased cardiac index (22%) and stroke volume (22%), while decreasing systemic vascular resistance.
- One child experienced severe hypotension. Restrictive cardiomyopathy patients showed no change in cardiac output but a trend toward hypotension.
Conclusions:
- Captopril acutely improves hemodynamics in pediatric congestive cardiomyopathy.
- Captopril may not be suitable for children with restrictive cardiomyopathy due to potential hypotension and lack of efficacy.
Abstract:
The acute hemodynamic effects of captopril were evaluated at cardiac catheterization in 16 children (age, 0.3-18 years) with cardiomyopathy. Twelve children had congestive cardiomyopathy, whereas four had restrictive cardiomyopathy. Hemodynamic measurements were obtained 30 and 60 minutes after the oral administration of captopril (0.5 mg/kg). Blood pressures were measured in the aorta, pulmonary artery, right atrium, and pulmonary capillary wedge position; cardiac outputs were measured by the thermodilution technique. Hemodynamic data could not be obtained after the administration of captopril in one child with congestive cardiomyopathy because of an immediate, severe hypotensive response. In 11 of 12 children with congestive cardiomyopathy, cardiac index increased by 22%, from 2.3 to 2.8 l/min/m2 (p less than 0.05), and stroke volume increased by 22%, from 23 to 28 ml/m2 (p less than 0.05). Systemic vascular resistance decreased from 32 to 21 units.m2 (p less than 0.01), but the mean aortic pressure did not change significantly. In contrast, four children with restrictive cardiomyopathy had no change in cardiac output after captopril, but there was a trend toward significant arterial hypotension (mean aortic pressure decreased from 78 to 59 mm Hg). Thus, captopril acutely reduced systemic vascular resistance and increased both cardiac output and stroke volume in children with congestive cardiomyopathy. In children with restrictive cardiomyopathy, however, captopril did not affect cardiac output, but it did decrease aortic pressure. These data indicate that captopril may benefit children with a congestive cardiomyopathy but that captopril probably should not be used in children with restrictive disease.