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Acute and long-term efficacy of perindopril in severe chronic congestive heart failure
D Flammang1, M Waynberger, A Chassing
1Department of Cardiology, Angouleme General Hospital, Saint Michel, France.
Insights
Perindopril effectively improved hemodynamics in patients with severe congestive heart failure, showing sustained benefits in cardiac index and reduced pulmonary capillary wedge pressure and mean arterial pressure over three months.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Congestive heart failure (CHF) management requires effective hemodynamic support.
- Perindopril is an angiotensin-converting enzyme (ACE) inhibitor used in cardiovascular therapy.
Purpose of the Study:
- To evaluate the short- and long-term hemodynamic effects of perindopril in patients with NYHA functional classes III and IV CHF.
- To assess the efficacy of perindopril in improving cardiac function and reducing pressures in severe heart failure.
Main Methods:
- A 3-month study involving 15 patients with CHF treated with oral perindopril (4 mg daily) alongside digitalis and diuretics.
- Hemodynamic parameters, ACE activity, and perindoprilat levels were measured acutely (2 titration days) and chronically (3 months).
- Patients had various underlying cardiopathies including ischemic, hypertensive, valvular, and dilated cardiomyopathy.
Main Results:
- Acute administration of perindopril (4 mg) increased cardiac index by 21% and decreased pulmonary capillary wedge pressure (PCWP) and mean arterial pressure (MAP) by 54% and 21%, respectively.
- After 3 months of treatment, cardiac index increased by 37% (p < 0.001), while PCWP and MAP decreased by 41% (p < 0.01) and 19% (p < 0.01), respectively.
- Six of the 11 remaining patients showed symptomatic improvement; however, 3 patients died due to worsening heart failure.
Conclusions:
- Perindopril demonstrates significant short- and long-term hemodynamic efficacy in patients with severe congestive heart failure.
- The drug effectively increases cardiac index and reduces filling pressures and systemic vascular resistance.
- Despite positive hemodynamic changes, careful monitoring is essential due to potential adverse events in severely ill patients.
Abstract:
To assess the short- and long-term hemodynamic efficacy of perindopril, 15 patients (12 men and 3 women) diagnosed with congestive heart failure were treated with oral perindopril (4 mg daily) for 3 months in association with digitalis and diuretic maintenance therapy. Patients were in New York Heart Association (NYHA) functional classes III and IV. Underlying cardiopathy was ischemic (6 patients), hypertensive (5 patients), valvular (2 patients), and dilated cardiomyopathy (2 patients). Hemodynamics, angiotensin-converting enzyme (ACE) activity, and perindoprilat (the active metabolite of perindopril) blood titration were measured at 2 periods. Acute assessment was performed over 2 titration days on oral perindopril 2 mg (day 1) and 4 mg (day 2); measurements were performed at rest and at 0, 1, 4, 6, 8, 12, and 24 hours. Chronic assessment was performed after 3 months of treatment with oral perindopril, 4 mg daily. During the study, 1 patient withdrew due to low systolic blood pressure (< 100 mm Hg) and 3 severely impaired patients died due to a worsening of heart failure during the study. Among the 11 remaining patients, 6 were symptomatically improved. On 4 mg perindopril administration, hemodynamic improvement was similar for peak values at both day 2 and at 3 months. At day 2, compared with baseline, cardiac index increased by 21% (p < 0.05) and pulmonary capillary wedge pressure (PCWP) and mean arterial pressure (MAP) decreased by 54% and by 21%, respectively (p < 0.01). Similarly, at 3 months, cardiac index increased by 37% (p < 0.001) and PCWP and MAP decreased by 41% and 19%, respectively (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)