Captopril in children with dilated cardiomyopathy: Acute and long-term effects in a prospective study of hemodynamic and hormonal effects
- 105 Downloads
Hemodynamic and hormonal effects of captopril were prospectively studied in 12 children (median age 5.8 years, range 4 weeks to 15 years) with dilated cardiomyopathy. A mean dose of 1.83 mg captopril/kg body weight was administered in three or four single doses depending on age.
Left ventricular volume, ejection fraction (EF), cardiac index (CI), and systemic vascular resistance (SVR) were noninvasively determined by two-dimensional (2D) and Doppler echocardiography before and 2 days and 3 months after the onset of treatment. Blood pressure and heart rate were recorded as well. Additionally, on the day hemodynamic measurements were made, plasma renin activity (PRA), serum aldosterone, and plasma atrial natriuretic peptide (ANP) concentrations were determined. Plasma catecholamines were measured before and 2 days after captopril treatment. Concomitant medication was kept constant during the short-term phase of captopril treatment. During long-term therapy, diuretics were reduced according to the clinical status. Stroke volume (SVI) (−7%), end-systolic (ESVI) (−31%), and enddiastolic (EDVI) (−21%) volume indexes were significantly reduced (p<0.05) during short-and long-term therapy. The remaining hemodynamic parameters showed only minor, statistically not significant, changes. During short-term therapy, median serum aldosterone levels fell from 138–88.5 pg/ml (p<0.05), and plasma ANP decreased from 144–94 pg/ml (p<0.05). After 3 months these effects were less marked and statistically no longer significant. Changes in PRA and plasma catecholamines were not statistically significant at any time.
Captopril thus exerted beneficial hemodynamic effects in these children with dilated cardiomyopathy by reducing left ventricular volume load. Acute hormonal drug effects were distinctly weakened during long-term therapy, while hemodynamic improvement was maintained.
Key WordsACE inhibitors Captopril Dilated cardiomyopathy Congestive heart failure
Unable to display preview. Download preview PDF.
- 2.Arendt RM, Gerbes AL, Stangl E, Ritter D, Zähringer J, Schultheiß HP, Kemkes B, Erdmann E (1988) Tonische und phasische Aktivität des endokrinen Herzens bei kardiovaskulären Patienten und Patienten mit Leberzirrhose. In: Kreye VA, Bussmann WD (eds)ANP-atriales natriuretisches Peptid und das kardiovaskuläre System. Steinkopff Verlag. Darmstadt, pp 179–189Google Scholar
- 4.Bayer O, Loogen, F, Wolter HH (eds) (1967)Die Herzkatheterisierung bei angeborenen und erworbenen Herzfehlern, 2nd edn. Thieme Verlag, Stuttgart, p 57Google Scholar
- 8.Cody R, Franklin K, Kluger J, Laragh J (1982) Sympathetic responsiveness and plasma norepinephrine during therapy of chronic congestive heart failure with captopril.Am J Cardiol 72:791–797Google Scholar
- 9.Cohn J, Archibald D, Ziesche S, Franciosa J, Harston W, Tristani F, Dunkman W, Jacobs W, Francis G, Flohr K, Goldman S, Cobb F, Shah P, Saunders R, Fletcher R, Loeb H, Hughes V, Baker B (1986) Effect of vasodilator therapy on mortality in chronic congestive heart failure: Results of a Veterans Administration Cooperative Study.New Engl J Med 314:1547–1552PubMedGoogle Scholar
- 10.Consensus Trial Group Study (1987) Effects of enalapril on mortality in severe congestive heart failure.New Engl J Med 316:1429–1435Google Scholar
- 18.Erbel R (1985) Funktionsdiagnostik des linken Ventrikels. In: Grube E (ed)Zweidimensionale Echokardiographie. G. Thieme Verlag. Stuttgart, New York, pp 347–360Google Scholar
- 25.Gerzer R, Weil J, Strom T (1985) Mechanisms of action of atrial natriuretic factor. Clinical consequences.Kli Wochenschr 64 (suppl VI):21–26Google Scholar
- 26.Goldberg S, Allen H, Marx G (1985)Doppler echocardiography. Lea & Feabinger, Philadelphia, pp 68–80Google Scholar
- 33.Mettauer B, Rouleau J, Bichet D, Kortas C, Manzini C, Tremblay G, Chatterjee K (1986) Differential long-term intrarenal and neurohormonal effects of captopril and prazosin in patients with chronic congestive heart failure: Importance of initial plasma renin activity.Circulation 79:492–502Google Scholar
- 34.Packer M (1985) Is the renin-angiotensin system really unnecessary in patients with severe chronic heart failure: The price we pay for evolution.JACC 6:171–173Google Scholar
- 37.Pilossoff V, Schöber JG, Peters D, Bühlmeyer K (1985) Non-invasive oscillometric measurements of systolic, mean and diastolic blood pressure in infants with congenital heart defects after operation. A comparison with direct blood pressure measurements.Eur J Pediatr 144:324–330CrossRefPubMedGoogle Scholar
- 38.Sachs L (1984)Angewandte Statistik, 6th edn. Springer-Verlag, Berlin, Heidelberg, New York, Tokyo, p 201Google Scholar
- 41.Staessen J, Lijnen P, Fagard R, Verschueren J, Amery A (1981) Rise of plasma aldosterone during longterm captopril treatment.New Engl J Med 304:1110Google Scholar