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Circulation, Vol 86, 1800-1809, Copyright © 1992 by American Heart Association
M Volpe, C Tritto, N DeLuca, S Rubattu, AF Mele, G Lembo, I Enea, P deCampora, V Rendina and M Romano
BACKGROUND. Angiotensin converting enzyme (ACE) inhibition exerts a
favorable effect on the response to exercise in heart failure. This study
was planned to define the influence of ACE inhibition on the adaptation to
volume overload. METHODS AND RESULTS. We studied the hemodynamic, hormonal,
and renal responses to acute volume expansion (sodium chloride, 0.9%, 0.25
ml.kg-1.min-1 for 2 hours) in patients with idiopathic or ischemic dilated
cardiomyopathy and mild heart failure (New York Heart Association class I
or II, ejection fraction < or = 50%). The patients were studied without
any pretreatment (n = 14) or after 1 week of treatment with the oral ACE
inhibitor quinapril at a dosage of 10 mg/day (n = 11). Seven patients were
studied during constant intravenous infusion with nitroglycerin (0.1
micrograms.kg- 1.min-1). The study groups had similar hemodynamic and
clinical characteristics and hormonal profile at baseline evaluation. In
the untreated patients, volume expansion did not increase left ventricular
end-diastolic volume measured by echocardiography and was associated with a
reduction in ejection fraction (p < 0.05) and with a paradoxical
increase in forearm vascular resistance (p < 0.05) estimated by
plethysmography. In addition, plasma atrial natriuretic factor did not
change, and plasma norepinephrine was increased by saline loading. In
contrast, in the patients treated with quinapril, volume expansion induced
an increase of both left ventricular volumes (p < 0.001) without
changing ejection fraction and reduced forearm vascular resistance (p <
0.05). In addition, in this group, plasma atrial natriuretic factor levels
increased (p < 0.05) and plasma norepinephrine did not change during
volume overload. During nitroglycerin infusion, volume expansion was
associated with peripheral vasodilatation, increases of left ventricular
volumes, and no change in ejection fraction. In this group, however, plasma
atrial natriuretic factor levels did not change in response to volume
overload. CONCLUSIONS. We conclude that pretreatment with the ACE inhibitor
quinapril significantly improves compromised responses to acute isotonic
volume overload in patients with dilated cardiomyopathy and mild heart
failure. The favorable influence of ACE inhibition on cardiovascular and
hormonal responses to volume expansion seems to be related to the cardiac
unloading produced by this treatment.
ARTICLES
Angiotensin converting enzyme inhibition restores cardiac and hormonal responses to volume overload in patients with dilated cardiomyopathy and mild heart failure
Prima Clinica Medica, Seconda Facolta di Medicina e Chirurgia, Universita degli Studi di Napoli, Naples, Italy.
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