Long-term hemodynamic and clinical efficacy of captopril therapy in ambulatory management of severe chronic congestive heart failure

The 6-month extended vasodilator efficacy of the oral angiotensin converting enzyme (ACE) inhibitor, captopril (CPT), was evaluated by sequential cardiac catheterization, nuclear scintigraphy, echocardiography, treadmill exercise, and symptomatology in nine patients with severe chronic left ventricular (LV) failure (CHF). CPT lowered LV filling pressure from 23 to 14 mm Hg acutely (p < 0.001) and to 14 mm Hg (p < 0.01) with continuous 6-month therapy; concomitantly CPT raised cardiac index from 2.03 to 2.46 L/min/m² initially (p < 0.02) and to 2.33 L/min/m² (p < 0.02) at 6 months. Simultaneously CPT raised LV ejection fraction from 0.21 to 0.25 acutely (p < 0.01) and to 0.30 (p < 0.01) at 6 months, and lowered LV end-diastolic dimension from 65 to 61 mm acutely (p < 0.001) and to 60 mm (p < 0.001) at 6 months. These beneficial actions of CPT on LV pump function raised treadmill exercise duration from 339 to 426 seconds initially (p < 0.05) and to 499 seconds (p < 0.05) at 6 months, while considerably reducing CHF symptomatology (p < 0.001). Thus ACE inhibition by CPT provides markedly beneficial sustained hemodynamic and clinical improvement in advanced LV failure without fluid accumulation or late vasodilator drug tolerance.