Effect of captopril on left ventricular end‐systolic pressure‐volume and stress‐shortening relations in severe cardiac failure

B. S. Lewis*, D. A. Halon, M. E. Rodeanu, A. Merdler, Y. Saggie, H. Schneider, T. Rosenfeld, R. Hardoff

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

The effects of captopril on cardiovascular dynamics and left ventricular (LV) contractility were studied in 11 patients with severe congestive heart failure and very poor global LV function. Pressures were measured using a flow‐guided catheter, cardiac output by thermodilution, and LV contraction and ejection fraction by simultaneous radionuclide angiography. Ventricular loading conditions were altered by sublingual isosorbide dinitrate to facilitate construction of LV pressure‐volume and stress‐shortening curves. Captopril decreased mean arterial pressure (p<0.02) and systemic vascular resistance, while stroke and cardiac index increased in most patients. Left ventricular ejection fraction increased from 18±5 to 22±7% (p<0.05), but contractility, assessed from endsystolic pressure‐volume and end‐systolic pressure‐shortening relations, was unchanged or decreased slightly. Heart rate and double product also tended to decrease. In contrast, arteriovenous oxygen difference widened and calculated total oxygen consumption increased during captopril therapy (p<0.05). The study showed that captopril improved forward blood flow, total oxygen extraction, and LV ejection fraction following the decreased impedance to LV emptying but not at the expense of an increase in ventricular contractility. This makes captopril an attractive drug for patients with end‐stage cardiac failure and a severely damaged myocardium.

Original languageEnglish
Pages (from-to)340-344
Number of pages5
JournalClinical Cardiology
Volume10
Issue number6
DOIs
StatePublished - Jun 1987
Externally publishedYes

Keywords

  • LV contractility
  • angiotensin converting enzyme inhibitors
  • pump failure

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