787-3 Efficacy and Safety of Early Administration of Intravenous Enalaprilat in Congestive Heart Failure Patients with Acute Pulmonary Edema

Abstract

The systemic (Swan-Ganz cathet r, brachial sphygmomanometer) and &-gional (2D pulsed doppler, paraaminohippurate and indocyanine green clearances) hemodynamic and blood gases effects of a single intravenous 2-hinfusion of 1 mg enalaprilat (E) were investigated within the 12 h following an acute pulmonary edema episode and compared to those of a placebo (P) in a randomized double-blind study performed in 20 CHF (III-IV NYHA) patients. The effects were investigated before and 2, 4 and 8 h after the onset of treatment infusion. At peak effect, and as compared to P, E significantly decreased pulmonary wedge pressure (-37 vs -10%, P = 0.001), diastolic and mean systemic (-21 vs -4%, P = 0.009, -18 vs -6%, p = 0.026) and pulmonary (-21 vs -8%, p = 0.040, -18 vs -9%, p = 0.046) arterial pressures, brachial and renal resistances (-44 vs -14%, P = 0.017, -22 vs -2%, P = 0.014) and significantly increased brachial and renal blood flows (+77 vs +8%, P = 0.036, + 12 vs 0%, p = 0.043) arterial oxygen tension (+ 2 vs -8%, P = 0.041) and saturation (+1vs -2%, P = 0.045) and finally tended to improve intra-pulmonary shunt (-18 vs -16%, P = 0.080). Simultaneously, E did not affect heart rate, cardiac output, systolic systemic and pulmonary arterial pressures, and carotid and hepato-splanchnic hemodynamics. Time courses of plasma electrolytes, creatinine and nitrogen clearances were not significantly different between E and P. We conclude that in this study early administration of intravenous enalaprilat was effective and well tolerated in CHF patients with acute pulmonary edema.