We evaluated long-term combined
vasodilator therapy (
hydralazine or
ecarazine +
isosorbide dinitrate) in 29 patients with chronic
congestive heart failure resistant to the optimal conventional
therapy. There were 24 men and 5 women, aged 28 to 76 years (mean 52 y/o). The etiology of
heart failure was
congestive cardiomyopathy in 24 patients, ischemic
cardiomyopathy in 4 patients and advanced
mitral regurgitation due to calcified mitral annulus in 1 patient. There were 21 patients in NYHA class III and 8 patients in NYHA class IV. All patients continued their previous therapeutic regimen during the period of this study. Hemodynamic measurements were performed with a triple lumen flow-directed balloon-tipped
catheter in 20 patients to evaluate the effects of
vasodilator therapy. In the rest of 9 patients, heart rate, blood pressure, chest X-ray examination for heart size (CTR) and M-mode echocardiograms for ejection fraction (EF) were monitored. The hemodynamic responses to the combined
vasodilator therapy in 20 patients showed significant decreases in afterload and preload concomitant with an increase in cardiac output. The noninvasive evaluation of combined
vasodilator therapy in 9 patients resulted in significant improvement in CTR and EF. We also noted a significant improvement in their symptoms of 29 patients. Side effects and
drug toxicity were uncommon during
vasodilator therapy. It is concluded that the combined
vasodilator therapy is most useful adjunctive
therapy in the management of severe refractory
heart failure. Moreover, long-term nonparenteral
vasodilators can be administered even at outpatient clinic without hemodynamic monitoring.