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[Short- and long-term effects of enalapril on the left ventricular function in patients with congestive heart
M Traina1, A Rotolo, R Trapani
1Cattedra di Fisiopatologia Cardiovasculare, Università degli Studi, Palermo.
Insights
Enalapril significantly improves systolic and diastolic function in severe congestive heart failure patients. This ACE inhibitor enhances ejection fraction and filling rates, showing persistent benefits over time.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Congestive heart failure (CHF) management often involves improving clinical and hemodynamic parameters.
- The specific impact of enalapril on left ventricular systolic and diastolic function in severe CHF requires further elucidation.
Purpose:
- To evaluate the effects of enalapril on left ventricular systolic and diastolic function indexes in patients with severe congestive heart failure (NYHA class III-IV).
Summary:
- This study assessed 12 severe CHF patients treated with digitalis and diuretics, evaluating enalapril's acute and chronic effects (5 mg twice daily for 3 months) using right heart catheterization, echocardiography, and radionuclide ventriculography.
- Acute enalapril administration improved ejection fraction (EF), stroke index (LVSI), filling rate (PFR), and reduced pulmonary wedge pressure (PWP) and peripheral vascular resistance (PVR).
- Chronic therapy led to significant, persistent increases in EF and PFR, with reduced left ventricular dimensions and increased shortening fraction.
Impact:
- Enalapril demonstrates efficacy in improving both systolic and diastolic left ventricular function in severe CHF.
- The observed improvements in cardiac function are sustained with chronic enalapril therapy.
- Findings support enalapril as a valuable therapeutic option for managing severe congestive heart failure.
Abstract:
Several studies have demonstrated that enalapril causes a clinical and hemodynamic improvement in patients with congestive heart failure. Nevertheless, the drug capability of influencing left ventricular systolic and diastolic indexes has not been evaluated. In 12 patients with severe congestive heart failure (NYHA class III-IV), treated with digitalis and diuretics, we performed a baseline evaluation through a right heart catheterization, echocardiography and radionuclide ventriculography. The effects on left ventricular systolic and diastolic function indexes after the administration of enalapril 5 mg by oral route have been evaluated. After 3 months of chronic therapy with enalapril 5 mg twice daily, we performed a further evaluation through echocardiography and radionuclide ventriculography. At the acute test we observed a significant improvement of left ventricular ejection fraction (EF), left ventricular stroke index (LVSI), and peak of filling rate (PFR), with a significant reduction of pulmonary wedge pressure (PWP) and peripheral vascular resistance (PVR). After 3 months of chronic therapy EF was significantly increased with respect to baseline values (37 +/- 6.9% vs 28.7 +/- 7.9%, p less than 0.05) and showed a further increase after the drug administration (from 37 +/- 6.9% to 48 +/- 5.4%, p less than 0.001). PFR showed a similar behaviour and reached at the follow-up evaluation normal values (from 1.97 +/- 0.7 edv/s to 2.57 +/- 0.6 efv/s, p less than 0.001). Furthermore, the echocardiographic dimensions of the left ventricle decreased significantly with a significant increase of shortening fraction. In conclusion, our study demonstrates that in patients with severe congestive heart failure enalapril improves the left ventricular systolic and diastolic function indexes and this improvement is persistent.