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Angiotensin converting enzyme inhibitors in bone marrow transplant recipients with depressed left ventricular
P W Kakavas1, R Ghalie, J E Parrillo
1Section of Cardiology, Rush Medical College, Rush Presbyterian St. Luke's Medical Center, Chicago, IL 60612-3833, USA.
Insights
Prophylactic enalapril treatment improved left ventricular ejection fraction (LVEF) in patients with pre-existing left ventricular dysfunction undergoing bone marrow transplantation (BMT). This intervention may prevent heart failure during BMT induction therapy.
Area of Science:
- Cardiology
- Hematology
- Pharmacology
Background:
- Pre-existing left ventricular dysfunction is a significant risk factor for heart failure during cyclophosphamide induction therapy before bone marrow transplantation (BMT).
- This cardiac complication frequently excludes patients from BMT eligibility at many medical centers.
Purpose of the Study:
- To investigate the efficacy of prophylactic enalapril treatment in preventing the deterioration of left ventricular dysfunction in patients undergoing BMT.
Main Methods:
- Six patients with baseline left ventricular ejection fraction (LVEF) < 50% received enalapril (5 mg orally twice daily) starting 48 hours before induction therapy.
- Treatment continued throughout the follow-up period, with serial radionuclide gated blood pool imaging (RGBP) to assess LVEF.
Main Results:
- All patients demonstrated an improved LVEF, increasing from 42 +/- 7% to 54 +/- 6% (P < 0.005).
- No patient experienced clinical deterioration during an average follow-up of 18 +/- 11 months.
Conclusions:
- Prophylactic enalapril administration appears to prevent the decline in left ventricular function in patients with mild, pre-existing left ventricular dysfunction undergoing BMT.
- Enalapril may be a beneficial therapeutic strategy for preserving cardiac function in this high-risk patient population.
Abstract:
Pre-existing left ventricular dysfunction in patients undergoing induction therapy with cyclophosphamide prior to bone marrow transplantation (BMT) has resulted in overt heart failure in a large number of patients. This fact excludes the majority of such patients from consideration for BMT at many centers. We sought to determine if prophylactic treatment with the angiotensin converting enzyme inhibitor enalapril prevents this deterioration in pre-existing left ventricular dysfunction. We treated six consecutive patients with initial left ventricular ejection fractions (LVEF) by radionuclide gated blood pool imaging (RGBP) of < 50% (42 +/- 7%) with enalapril 5 mg orally twice per day started 48 h prior to induction therapy and continued throughout the follow-up period. Serial RGBP imaging demonstrated an increase in LVEF in all patients to 54 +/- 6% (P < 0.005). No patient experienced clinical deterioration during a follow-up period of 18 +/- 11 months. We conclude that prophylactic treatment with enalapril may prevent deterioration in pre-existing mild left ventricular dysfunction during BMT.