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Left ventricular performance after intravenous infusion of captopril in patients with congestive heart failure
G Arcidiacono1, G O Asmundo, E Battaglia
1First Department of Internal Medicine, University of Catania Medical School, Italy.
Insights
Intravenous captopril significantly improved left ventricular function and reduced blood pressure in patients with congestive heart failure (CHF). Echocardiography demonstrated enhanced cardiac performance, suggesting a potential new administration route for this essential medication.
Area of Science:
- Cardiology
- Pharmacology
- Medical Imaging
Background:
- Oral captopril, an angiotensin-converting enzyme inhibitor, is established for congestive heart failure (CHF) treatment.
- The efficacy and impact of intravenous (IV) captopril administration for CHF remain less understood.
Purpose of the Study:
- To investigate the effects of intravenous bolus captopril on left ventricular function in patients with CHF.
- To assess changes in cardiac output, ejection fraction, and blood pressure following IV captopril administration.
Main Methods:
- Ten patients with NYHA class II-III CHF received a 25 mg IV bolus of captopril.
- Left ventricular function parameters were evaluated using M-mode echocardiography before and 30 minutes post-infusion.
- Systolic and diastolic blood pressures were also monitored.
Main Results:
- Eight out of ten patients exhibited significant improvements in left ventricular performance indices.
- Ejection fraction, cardiac output, and fractional shortening increased significantly, while end-systolic diameter and stress decreased.
- Systolic and diastolic blood pressures were significantly reduced by 17% and 11%, respectively.
Conclusions:
- Intravenous captopril administration led to significant improvements in left ventricular function and parietal kinesis.
- Observed benefits may stem from reduced parietal stress, enhanced coronary flow, tissue renin-angiotensin-aldosterone system inhibition, and captopril's scavenging action.
- M-mode echocardiography effectively detected improvements in cardiac wall motion abnormalities.
Background:
Although oral administration of captopril, an angiotensin-converting enzyme inhibitor, is effective for the treatment of congestive heart failure (CHF), the effect of its intravenous (iv) administration is not well known.
Methods And Results:
Ten patients (age range 48-72 years), with CHF belonging to the second and third NYHA class, were given an iv bolus of 25 mg of captopril. Before and 30 minutes after the infusion of captopril, a number of parameters of the left ventricular function were evaluated by echocardiography IREX 3 M-B Mode. Eight patients showed a significant improvement of left ventricular performance indices. In fact, the ejection fraction (13.8%, p < 0.05), the cardiac output (24%, p < 0.001), the circumferential shortness fraction (29.9%, p < 0.05), and the fraction shortening (16.0%, p < 0.005) increased significantly, whereas the end-systolic diameter (21%, p < 0.001), the endsystolic stress (23.8%, p < 0.01) and the left ventricle ejection time (4.8%, p < 0.05) decreased significantly. Systolic and diastolic blood pressure values also underwent a significant reduction by 17% and 11% (p < 0.01 and p < 0.05 respectively). No evident correlation between the improvement of the left ventricular function and the basal renin rates was noticed.
Conclusions:
A significant improvement of parietal kinesis was observed especially in those segments which showed movement abnormalities (hypokinesia and akinesia) and in many cases this was detected by M-B Mode echocardiography. Our findings may be the result of the following factors: 1) reduction of parietal stress; 2) increased district coronary flow; 3) inhibition of tissue renin-angiotensin-aldosterone system; and 4) "scavenging" action exerted by the SH group of captopril.