In 42 patients with moderate-to-severe
congestive heart failure (CHF), the acute hemodynamic and neurohumoral response to the converting
enzyme inhibitors (CEIs)
captopril (
CPT) and
teprotide were measured. Plasma
renin activity (PRA) was elevated and correlated with control plasma
norepinephrine (PNE) but not with any of the control hemodynamics. Acutely after CEIs, significant (p less than 0.001) decreases in right atrial pressure, pulmonary artery pressure (PAP), capillary wedge pressure (PCWP), mean arterial pressure (MAP), total systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), and heart rate (HR, p less than 0.002), as well as an increase in cardiac index (p less than 0.001), were observed. Control PRA correlated with the degree of hemodynamic change for PAP (r = -0.64), PCWP (r = -0.66), SVR (r = -0.61), and PVR (r = -0.61). Long-term
CPT therapy in 12 of these patients resulted in symptomatic improvement and a marked increase in exercise tolerance (7.4 to 10.4 minutes, p less than 0.009). These data suggest that CEIs effect beneficial acute hemodynamic improvements in depressed left ventricular function, leading to substantial reduction in disabling symptomatology and augmentation of exercise capacity in patients with stable severe CHF. Thus,
CPT appears to provide well-tolerated, effective long-term ambulatory
vasodilator therapy for advanced cardiac dysfunction.