[Rest and effort hemodynamics during long-term treatment of dilated and ischemic cardiomyopathy with captopril]

In the present study 13 patients with severe chronic heart failure were investigated by right heart catheterization at rest and during handgrip before and 6 months after treatment with captopril (mean dose 2 X 37.5 mg per day). Before initiating captopril therapy all patients were clinically stable on digitalis and diuretics. During the observation period 3 patients died suddenly. Of the remaining cases, 5 had dilated cardiomyopathy and 5 ischemic heart disease. After 6 months, resting hemodynamic measurements changed as follows: systemic vascular resistance decreased from 1594 to 1284 dyn X sec X cm-5 (p less than 0.005), left ventricular end-diastolic pressure decreased from 17 to 10 mm Hg (p less than 0.01) and stroke volume index increased from 32 to 40 ml/m2 (p less than 0.05). Before captopril, 9 patients showed no increase or even a decrease of stroke work index during isometric exercise, whereas after captopril 5 out of the 10 patients showed an increase in stroke work index. The results demonstrate that, in patients with severe chronic heart failure, long-term afterload reduction with captopril 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 10 patients.