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[Long-term treatment of severe cardiac insufficiency with captopril]
Insights
Captopril treatment significantly improved cardiac function and reduced heart failure symptoms in patients with severe chronic heart failure. The drug demonstrated lasting hemodynamic benefits and clinical improvement in most patients.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Severe chronic heart failure (NYHA stages III-IV) significantly impacts patient quality of life and prognosis.
- Existing treatments often have limitations in efficacy and side effect profiles.
Purpose:
- To evaluate the long-term efficacy and hemodynamic effects of captopril in patients with severe chronic heart failure.
- To assess the impact of captopril on cardiac index, peripheral resistance, and clinical status.
Summary:
- Twenty-three patients with cardiomyopathy and severe chronic heart failure received long-term captopril treatment (75-300 mg/day).
- Acute captopril administration increased cardiac index and decreased peripheral resistance, total pulmonary resistance, and pulmonary diastolic pressure.
- After a follow-up of 12 months, 22 patients showed marked and lasting clinical improvement, with 18 progressing to NYHA stage II and 4 to stage III.
Impact:
- Captopril demonstrates significant short-term hemodynamic benefits and sustained long-term clinical improvement in patients with severe chronic heart failure.
- The findings support captopril as an effective therapeutic option for managing advanced heart failure.
- Monitoring for potential side effects like renal failure is crucial during treatment.
Abstract:
23 patients with a mean age of 62 +/- 7 years and suffering from a cardiomyopathy with severe chronic heart failure (16 patients in stage IV of the New York Association (NYHA) classification and 7 in stage III NYHA) received long term treatment with captopril (9 patients received 75 mg/day, 9 received 150 mg/day and 5 received 300 mg/day) with a follow-up of 12 +/- 9 months. Following the acute administration of captopril, there was an increase in the cardiac index (Cl) (2.76 +/- 0.56 vs 2.10 +/- 0.4 l . min-1 . m-2, p less than 0.001) between the 4th and 6th hour, a significant decrease in peripheral resistance (PR) (1416 +/- 304 vs 1094 +/- 406 dynes/s/cm-5, p less than 0.001), total pulmonary resistance (TPR) (537 +/- 228 vs 660 +/- 258 dynes/s/cm-5, p less than 0.01) and pulmonary diastolic pressure (PDP) (15.4 +/- 7.2 vs 18.6 +/- mm Hg, p less than 0.001). An early (3rd day) and reversible renal failure caused the treatment to be suspended in one patient. In the 22 other patients, a marked and lasting clinical improvement was obtained (18 patients with stage II NYHA and 4 with stage III NYHA). The beneficial haemodynamic effects persisted until the 4th month in 14 patients (Cl: 2.38 +/- 0.4 vs 2.10 +/- 0.4 l . min-1 . m-2, p less than 0.1; PR: 1828 +/- 314 vs 2054 +/- 406 dynes/s/cm-5, p less than 0.01; TPR: 526 +/- 284 vs 660 +/- 258 dynes/s/cm-5, p less than 0.01; PDP: 16.8 +/- 8.7 vs 18.6 +/- 8.6 mmHg, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)