TY - JOUR
T1 - Hemodynamic and clinical significance of the pulmonary vascular response to long-term captopril therapy in patients with severe chronic heart failure
AU - Packer, M.
AU - Lee, W. H.
AU - Medina, N.
AU - Yushak, M.
N1 - Funding Information:
From the Division of Cardiology, Department of Medicine, Mount Sinai School of Medicine of The City University of New York, New York, New York. Dr. Packer is the recipient of Research Career Development Award K04-HL-01229 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland. Manuscript received February 6, 1985; revised manuscript received April I, 1985, accepted April 22, 1985. Address for reprints: Milton Packer, MD, Division of Cardiology, Mount Sinai Medical Center, One Gustave Levy Place, New York, New York 10029.
PY - 1985
Y1 - 1985
N2 - Exercise capacity in patients with left heart failure is closely related to the performance of the right ventricle and the pulmonary circulation. To determine the significance of changes in pulmonary resistance during longterm vasodilator therapy, hemodynamic studies were performed before and after 1 to 3 months of treatment with captopril in 75 patients with severe chronic left heart failure. Patients were grouped according to the relative changes in pulmonary and systemic resistances during long-term therapy: patients in Group I (n = 24) showed greater decreases in pulmonary arteriolar resistance (PAR) than in systemic vascular resistance (SVR) (% Δ PAR/% Δ SVR>1.0), whereas patients in Group II showed predominant systemic vasodilation (% Δ PAR/% Δ SVR 1.0). Despite similar changes in systemic resistance, patients in Group I showed greater increases in cardiac index, stroke volume index and left ventricular stroke work index (p < 0.01 to 0.001) but less dramatic decreases in mean systemic arterial pressure (p < 0.02) than did patients in Group II. Despite similar changes in left ventricular filling pressure, patients in Group I showed greater decreases in mean pulmonary artery and mean right atrial pressures (p < 0.02 to 0.01) than did patients in Group II. Pretreatment variables in Groups I and II were similar, except that plasma renin activity was higher (8.7 ± 2.1 versus 3.0 ± 0.6 ng/ml per h) and serum sodium concentration was lower (133.1 0.9 versus 137.1 < 0.6 mEq/liter) in Group II than in Group I (both p < 0.05). Both groups improved clinically after 1 to 3 months, but symptomatic hypotension occurred more frequently in Group II than in Group 1(30 versus 8%) (p < 0.005). These findings indicate that changes in the pulmonary circulation modulate alterations in both right and left ventricular performance during the treatment of patients with left heart failure. Hyponatremic patients are likely to experience symptomatic hypotension with captopril because they are limited in their ability to increase cardiac output as a result of an inadequate pulmonary vasodilator response to the drug.
AB - Exercise capacity in patients with left heart failure is closely related to the performance of the right ventricle and the pulmonary circulation. To determine the significance of changes in pulmonary resistance during longterm vasodilator therapy, hemodynamic studies were performed before and after 1 to 3 months of treatment with captopril in 75 patients with severe chronic left heart failure. Patients were grouped according to the relative changes in pulmonary and systemic resistances during long-term therapy: patients in Group I (n = 24) showed greater decreases in pulmonary arteriolar resistance (PAR) than in systemic vascular resistance (SVR) (% Δ PAR/% Δ SVR>1.0), whereas patients in Group II showed predominant systemic vasodilation (% Δ PAR/% Δ SVR 1.0). Despite similar changes in systemic resistance, patients in Group I showed greater increases in cardiac index, stroke volume index and left ventricular stroke work index (p < 0.01 to 0.001) but less dramatic decreases in mean systemic arterial pressure (p < 0.02) than did patients in Group II. Despite similar changes in left ventricular filling pressure, patients in Group I showed greater decreases in mean pulmonary artery and mean right atrial pressures (p < 0.02 to 0.01) than did patients in Group II. Pretreatment variables in Groups I and II were similar, except that plasma renin activity was higher (8.7 ± 2.1 versus 3.0 ± 0.6 ng/ml per h) and serum sodium concentration was lower (133.1 0.9 versus 137.1 < 0.6 mEq/liter) in Group II than in Group I (both p < 0.05). Both groups improved clinically after 1 to 3 months, but symptomatic hypotension occurred more frequently in Group II than in Group 1(30 versus 8%) (p < 0.005). These findings indicate that changes in the pulmonary circulation modulate alterations in both right and left ventricular performance during the treatment of patients with left heart failure. Hyponatremic patients are likely to experience symptomatic hypotension with captopril because they are limited in their ability to increase cardiac output as a result of an inadequate pulmonary vasodilator response to the drug.
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U2 - 10.1016/S0735-1097(85)80125-X
DO - 10.1016/S0735-1097(85)80125-X
M3 - Article
C2 - 2993397
AN - SCOPUS:0022372020
SN - 0735-1097
VL - 6
SP - 635
EP - 645
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 3
ER -