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Determinants of clinical response and survival in patients with congestive heart failure treated with captopril
Insights
Chronic captopril therapy improved heart failure symptoms and exercise tolerance in patients. However, high mortality persisted, primarily linked to the severity of cardiac dysfunction.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic congestive heart failure (CHF) presents a significant clinical challenge.
- Refractory CHF cases require evaluation of novel therapeutic strategies.
Purpose of the Study:
- To assess the 18-month efficacy of chronic ambulatory captopril (CPT) therapy in patients with refractory CHF.
- To identify predictors of clinical response and mortality in this patient cohort.
Main Methods:
- Utilized cardiac catheterization, treadmill exercise, nuclear scintigraphy, and echocardiography for comprehensive patient evaluation.
- Assessed clinical improvement using the New York Heart Association functional classification and symptomatology.
Main Results:
- 63% of patients showed clinical improvement within 2 months, sustained in 63% at 18 months.
- Exercise tolerance increased significantly in over 64% of patients.
- Stroke work index (SWI) was a key predictor of both clinical response and long-term survival, with higher SWI correlating to better outcomes.
Conclusions:
- Chronic ambulatory captopril therapy offers sustained symptomatic and functional benefits for advanced CHF patients.
- Despite improvements, overall mortality remains high, emphasizing the critical role of baseline cardiac dysfunction severity, particularly SWI, in determining prognosis.
Abstract:
The efficacy of chronic ambulatory captopril (CPT) therapy was evaluated over an 18-month period in 36 patients with refractory chronic congestive heart failure (CHF) by cardiac catheterization, treadmill exercise, nuclear scintigraphy, echocardiography, and symptomatology. Clinical improvement to New York Heart Association functional class I or class II was observed in 63% of the patients (20 of 32) after 2 months of treatment; this amelioration of CHF symptoms was sustained in 63% of the patients (10 of 16) at 18 months. Exercise tolerance increased in 64% of the patients (16 of 25) at early follow-up and in 79% (11 of 14) at late follow-up. Univariate analysis revealed that the pre- and post-CPT stroke work indices (SWI) and the post-CPT cardiac index related to favorable long-term clinical response. Fourteen CHF patients (39%) died during the 18-month follow-up. Univariate analysis revealed that the pretreatment SWI, right atrial pressure, plasma norepinephrine concentration, and echocardiographic shortening fraction were significant predictors of mortality. Multivariate analysis indicated that the SWI was the principal determinant of survival: the 18-month cumulative survival rate for CHF patients with a SWI less than 32 gm . m/m2 was 44% compared to 88% when the SWI was greater than 32 gm . m/m2. Thus, CPT results in sustained symptomatic and functional improvements in patients with advanced CHF, but the mortality remains high and is primarily related to the severity of cardiac dysfunction.