Open AccessEffect of captopril on left ventricular end‐systolic pressure‐volume and stress‐shortening relations in severe cardiac failure
Author(s) -
Lewis B. S.,
Halon D. A.,
Rodeanu M. E.,
Merdler A.,
Saggie Y.,
Schneider H.,
Rosenfeld T.,
Hardoff R.
Publication year - 1987
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960100608
Subject(s) - medicine , captopril , cardiology , ejection fraction , isosorbide dinitrate , heart failure , stroke volume , cardiac output , contractility , cardiac index , afterload , vascular resistance , blood pressure , anesthesia
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.