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      Acute Filling Pattern Changes of the Failing Left Ventricle after Captopril as Related to Ventricular Structure

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          Abstract

          In congestive heart failure captopril modifies the left ventricular filling pattern mainly by unloading the heart. We investigated whether the structural characteristics of the left ventricle may influence the acute effects of captopril on this pattern in patients with untreated hypertensive (H group, 6 patients) or idiopathic (I group, 14 patients) cardiomyopathy. We evaluated changes of pulsed Doppler mitral flow, of systemic arterial and wedge pulmonary pressures 40 min after 25 mg captopril administered sublingually, and correlated these changes with the M-mode echocardiographic relative wall thickness index (h/r). Baseline mean arterial pressure (H = 137 ± 20 mm Hg, mean ± SD, I = 95 ± 19 mm Hg; p < 0.001), and h/r (H = 0.38 ± 0.03,1 = 0.28 ± 0.09; p < 0.05) were greater in the high blood pressure group; wedge pressure, echocardiographic biplane ejection fraction, and Doppler indexes of the left ventricular filling were similar in the two populations. After captopril, ejection fraction did not change significantly, mean arterial pressure decreased significantly in hypertensive patients (H group, baseline = 137 ± 20, captopril = 119 ± 10, p = 0.02; I group, baseline = 95 ± 19, captopril = 90 ± 24, p = nonsignificant), and the wedge pressure was reduced by the same extent in both groups (H group, baseline = 27.7 ± 3, captopril = 21 ± 7, p < 0.05; I group, baseline = 20 ± 12, captopril = 15 ± 8, p < 0.05). In the H group early mitral flow increased [(E wave integral) × (mitral annulus area)] by 38 ± 15%, and was almost steady in the I group (-1.3 ± 30%; group H vs. I = p < 0.01); late mitral flow [(A wave integral) × (mitral annulus area)] showed a pattern exactly opposite to this (H = +0.4 ± 40%, I = +38 ± 19; p < 0.01). In the whole population there was a significant correlation between the early /late flow ratio variations and baseline h/r (r = 0.6, p < 0.05). In chronic congestive heart failure, changes in left ventricular filling with captopril are related to h/r: a higher index, as recorded in the H group, is associated with ‘true normalization’ of the filling pattern after captopril; a lower index, as recorded in the I group, is associated with ‘pseudonormalization’ despite a similar decrease of left ventricular filling pressure.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          0008-6312
          1421-9751
          1996
          1996
          19 November 2008
          : 87
          : 2
          : 153-160
          Affiliations
          Istituto di Cardiologia dell’Università degli Studi, Centro di Studio per le Ricerche Cardiovascolari del Consiglio Nazionale delle Ricerche, Centro Cardiologico -Fondazione ‘Monzino’ IRCCS, Milano, Italia
          Article
          177079 Cardiology 1996;87:153–160
          10.1159/000177079
          8653733
          © 1996 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 8
          Categories
          Noninvasive and Diagnostic Cardiology

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