Abstract
In order to evaluate the acute effects of pharmacological blockade of the renin-angiotensinogen system in patients with chronic left ventricular volume overload, 50 mg of the converting enzyme inhibitor captopril were administered to 4 patients with aortic insufficiency and 5 patients with mitral regurgitation. Mean aortic pressure decreased from 108±17 to 89±18 mmHg (P<0.001) and systemic vascular resistance decreased from 2,300±1,087 to 1,540±547 dyn s cm−5 (p<0.01). Left ventricular filling pressures decreased significantly. This resulted in an increase in cardiac index from 2.6±0.8 to 2.9±0.7 1/min/m2 (p<0.001) and an increase in the forward stroke volume index from 31±7 to 37±7 ml/m2 (p<0.001). Left ventricular end-diastolic and end-systolic volumes decreased significantly (p<0.05). No changes in left ventricular ejection fractions and heart rate were observed. Regurgitant stroke volume was reduced from 58±27 to 32±9 ml/m2 (p<0.01) and the regurgitant fraction from 64±13 to 46±8% (p<0.001). Coronary sinus blood flow decreased from 174±57 to 144±58 ml/min (p<0.05); coronary vascular resistance remained constant. Myocardial oxygen consumption was reduced from 26±11 to 21±12 mlO2/min (p<0.05). Captopril, therefore, has benefical hemodynamic effects in patients with chronic left ventricular volume overload due to aortic or mitral incompetence. Cardiac performance is increased at reduced metabolic costs.
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