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[Hemodynamic effect of captopril in children with dilated cardiomyopathy]
1Pädiatrische Kardiologie, Deutsches Herzzentrum, München, Bundesrepublik Deutschaland.
Insights
Captopril significantly reduced end-systolic and end-diastolic ventricular volumes in children with dilative cardiomyopathy. These hemodynamic improvements were sustained with long-term captopril treatment, with minimal adverse effects.
Area of Science:
- Pediatric Cardiology
- Pharmacology
- Cardiovascular Physiology
Context:
- Dilative cardiomyopathy in children presents significant therapeutic challenges.
- Hemodynamic assessment is crucial for managing pediatric heart conditions.
- Angiotensin-converting enzyme (ACE) inhibitors like captopril are used in cardiovascular medicine.
Purpose:
- To prospectively evaluate the hemodynamic effects of captopril in pediatric patients with dilative cardiomyopathy.
- To assess both short-term and long-term impacts of captopril on cardiac function.
- To determine the safety and tolerability of captopril in this population.
Summary:
- Twelve children with dilative cardiomyopathy received captopril, with doses adjusted by weight.
- Short-term captopril administration significantly reduced end-systolic volume index (ESVI), end-diastolic volume index (EDVI), and stroke volume index (SVI).
- These reductions were maintained during long-term therapy, with minimal changes in ejection fraction (EF), cardiac index (CI), systemic resistance (Rs), blood pressure, and heart rate. Only one child experienced transient adverse effects.
Impact:
- Captopril demonstrates significant efficacy in improving ventricular volumes in pediatric dilative cardiomyopathy.
- The drug is well-tolerated, suggesting a favorable risk-benefit profile for long-term use.
- Findings support captopril as a valuable therapeutic option for children with this condition.
Abstract:
Hemodynamic effects of captopril were prospectively studied in 12 children suffering from dilative cardiomyopathy. Before the administration of the drug all patients were put on a stable medication of diuretics and/or glycosides. A median daily dose of 1.83 mg captopril/kg body weight was given in 3 or 4 single doses depending on age. Median body weight of the children was 18.6 kg (range 2.7-42.2) and the median age was 5.8 years (range 0.2-15). Left ventricular volume was determined in systole and diastole using 2-D echo, and the stroke volume als well as the ejection fraction were calculated. Cardiac index (CI) and systemic resistance (Rs) were measured by Doppler echo. Blood pressure and heart rate were recorded at each echo registration. ESVI (-32%), EDVI (-21%) and SVI (-7%) were significantly (p less than 0.05) reduced by short-term captopril treatment. This effect was maintained under long-term therapy. EF, CI, Rs, blood pressure and heart rate showed only minor changes under captopril. Adverse effects were recorded only in one child. They disappeared after dose reduction.