Long-term captopril therapy in congestive heart failure: Serial hemodynamic and echocardiographic changes

Abstract

Ten patients with refractory congestive heart failure (CHF) were followed serially for systemic hemodynamic (radionuclide techniques) and M-mode echocardiographic changes during long-term captopril therapy with optimum doses. After 1 week of maintenance captopril therapy, all patients were clinically improved. This was associated with a significant ( p < 0.05) reduction of total blood volume (−6 ± 2% N), mean blood pressure (−9 ± 3 mm Hg), and peak systolic left ventricular wall stress (−50 ± 19 × 10 3 dynes/cm 2). At the end of 2 months of maintained therapy, mean blood pressure reduction was −12 ± 4 mm Hg ( p < 0.05); further hemodynamic improvement was manifested by a significant shortening of pulmonary mean transit time (−3.7 ± 1.33 seconds, p < 0.05). Echocardiographic data revealed an increase in end-diastolic septal wall thickness (+0.13 ± 0.05, p < 0.05) and left ventricular posterior wall thickness (+0.13 ± 0.03, p < 0.05), and further reduction in peak systolic stress (−84 ± 23 × 10 3 dynes/cm 2, p < 0.05). The present study indicates the importance of measuring peak systolic wall stress in the follow-up of CHF patients. Moreover, we found that for functional circulatory evaluation during vasodilator therapy, the radionuclide first-pass methods were more helpful than both M-mode echocardiography and radionuclide gated blood pool techniques.