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Haemodynamics at rest and during isometric exercise under long-term treatment with captopril in dilated and ischaemic
P Greminger1, P Eichhorn, O M Hess
1Department of Internal Medicine, Medical Policlinic, Zurich, Switzerland.
Insights
Captopril treatment improved heart function in severe chronic heart failure patients. The drug reduced resting heart rate and improved cardiac output, with some patients showing better performance during exercise.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Severe chronic heart failure significantly impairs cardiac function and exercise capacity.
- Current treatments aim to manage symptoms and improve hemodynamics.
Purpose of the Study:
- To evaluate the long-term effects of captopril on hemodynamics and left ventricular performance in patients with severe chronic heart failure.
- To assess changes at rest and during isometric exercise.
Main Methods:
- Right heart catheterization was performed on 12 patients with severe chronic heart failure (dilated cardiomyopathy or ischemic heart disease).
- Measurements were taken at rest and during handgrip isometric exercise before and after 6 months of captopril treatment.
- Concomitant digitalis and diuretic therapy remained unchanged.
Main Results:
- After 6 months of captopril, resting hemodynamics showed decreased heart rate, mean arterial pressure, pulmonary capillary pressure, and total vascular resistance, with increased stroke volume index and stroke work index.
- During isometric exercise, captopril reduced total vascular resistance and increased stroke volume index and stroke work index.
- Prior to captopril, 11 patients had no improvement or a decrease in stroke work index during exercise; after treatment, 5 patients showed an increase.
Conclusions:
- Long-term captopril treatment in severe chronic heart failure effectively lowers preload and afterload.
- This leads to significant improvements in left ventricular performance at rest.
- Captopril also demonstrated potential to improve left ventricular function during isometric exercise in a subset of patients.
Abstract:
In the present study 12 patients with severe chronic heart failure (7 with dilated cardiomyopathy and 5 with ischaemic heart disease) underwent right heart catheterization at rest and during isometric exercise by handgrip before and 6 months after treatment with captopril (mean dose 2 X 39.6 mg/day) while concomitant digitalis and diuretics were unchanged. After 6 months resting haemodynamics changed as follows: decrease in heart rate, mean arterial pressure, pulmonary capillary pressure and total vascular resistance; increase in stroke volume index and stroke work index. During handgrip the following changes were observed after captopril: decrease in total vascular resistance; increase in stroke volume index and stroke work index. Before captopril 11 patients showed no increase or even a decrease in stroke work index during isometric exercise, whereas after captopril 5 out of the 12 patients showed an increase in stroke work index. The results demonstrate that in patients with severe chronic heart failure long-term treatment with captopril lowers preload and afterload, which is accompanied by a significant improvement in left ventricular performance at rest. Furthermore, during isometric exercise after captopril an improvement in left ventricular function was found in 5 out of 12 patients.