Effect of acute angiotensin converting enzyme inhibition on left ventricular diastolic filling in patients with congestive heart failure: Relation to right ventricular volume

Konstam, Marvin A.; Kronenberg, Marvin W.; Udelson, James E.; Metherall, Jeanne; Dolan, Noreen; Edens, Tonya R.; Howe, Donna; Yusuf, Salim; Youngblood, M.; Toltsis, Hasida

doi:10.1016/0735-1097(90)92558-j

Cited by 12 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In patients with significantly impaired left ventricular function, 1.25 mg enalaprilat reduced ventricular filling volumes (RVEDV, RVESV) and increased RVEF significantly. These effects appear to be most likely due to beneficial actions of enalaprilat on left ventricular loading, which positively influences right ventricular function via ventricular interdependence [19]. In the present study, PAP was also reduced by enalaprilat, which may have contributed to the improved right ventricular function via reduction of right ventricular afterload.…”

Section: Discussionsupporting

confidence: 53%

Cardiorespiratory effects of continuous i.v. administration of the ACE inhibitor enalaprilat in the critically ill.

Boldt

Müller

Härter

et al. 1995

Brit J Clinical Pharma

View full text Add to dashboard Cite

1 Cardiorespiratory effects of long-term, continuous i.v. administration of the ACE inhibitor enalaprilat were studied. 2 Forty-five consecutive critically patients suffering from trauma or postoperative complications were randomly separated into three groups (15 patients in each group) receiving either 0.25 mg h-1 or 0.50 mg h-1 enalaprilat, respectively, or saline solution as placebo (= control group). The infusion was continued for 5 days. 3 Haemodynamic and respiratory parameters were intensively monitored on admission to the intensive care unit (= 'baseline' values) and daily during the next 5 days. 4 Mean arterial blood pressure (MAP) decreased significantly only in the enalaprilattreated patients, whereas heart rate (HR) remained unchanged in these patients. 5 Pulmonary capillary wedge pressure (PCWP) and pulmonary artery pressure (PAP) were decreased by enalaprilat (0.50 mg h-1: PAP (mean ± s.d.) decreased from 28.0 ± 4.1 to 24.0 ± 3.0 mm Hg) and remained significantly lower than in the control group. In the untreated control group, cardiac index (CI), oxygen consumption (VO2I) and oxygen delivery (DO2I) significantly decreased, which was blunted by enalaprilat infusion. Oxygen extraction (02-extr) increased in both enalaprilat groups (0.25 mg h-1: from 26.1 ± 5.5 to 30.4 ± 4.0%; 0.50 mg h-l: 25.2 ± 5.6 to 30.9 ± 4.4%) and decreased in the control patients.6 Right ventricular haemodynamics improved by enalaprilat infusion (0.50 mg h-1: RVEF increased from 40.0 ± 3.5 to 45.5 ± 4.0%). Lactate plasma concentrations decreased in the group with 0.50 mg h-1 enalaprilat (from 1.9 ± 1.0 to 1.3 ± 0.3 mg dF-') and increased in the control patients.7 Continuous infusion of the ACE inhibitor enalaprilat exerted beneficial cardiorespiratory effects in the critically ill. The widespread common risk of altered perfusion with decreased CI, DO2, VO2, 02-extr and increased lactate concentration was blunted by enalaprilat infusion.8 Although 0.5 mg h-1 enalaprilat was most effective, a dose of 0.25 mg h-1 also showed beneficial haemodynamic effects in the critically ill.

show abstract

Section: Discussionsupporting

confidence: 53%

Cardiorespiratory effects of continuous i.v. administration of the ACE inhibitor enalaprilat in the critically ill.

Boldt

Müller

Härter

et al. 1995

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…The use of calcium-channel blockers such as nifedipine or diltiazem has shown a somewhat more promising improvement in hemodynamics and in symptoms in patients with primary pulmonary hypertension. However, high doses of these drugs are required to achieve a substantial hemodynamic response [ 3 11. Therapy is often limited by untoward side effects.…”

Section: Rv Pressure Overload: Cor Pulmonalementioning

confidence: 99%

The forgotten chamber: The importance of the right ventricle

Rigolin

Robiolio

Wilson

et al. 1995

Cathet. Cardiovasc. Diagn.

110

View full text Add to dashboard Cite

Historically, the right heart was viewed as less important than the left heart in the maintenance of normal overall hemodynamic performance. However, there is now considerable evidence that emphasizes the significance of intact right ventricular (RV) function. The RV's anatomy and physiology are reviewed in order to provide insight into how changes in volume can be accommodated within a low-pressure environment and how this contributes to hemodynamic stability. The interdependent relationship between the right and left ventricles is also explored. The contribution of RV performance to overall hemodynamics is best exemplified when the RV becomes diseased. RV infarction, atrial septal defect, and cor pulmonale are used as examples to illustrate the dramatic sequelae associated with RV dysfunction, as well as to identify the RV's specific adaptive mechanisms.

show abstract

“…enalaprilat was administered to patients with ischaemic left ventricular dysfunction but after the induction of anaesthesia. At the time of the peak effect of enalaprilat, 16 there was no signi®cant change in blood pressure; no severe hypotension occurred, so that no vasopressor was required. Similar results were found by Boldt and co-workers when larger doses of enalaprilat (about 40 mg kg ±1 ) were used after induction of anaesthesia in patients with ischaemic heart disease but without left ventricular dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Haemodynamic and renal effects of intravenous enalaprilat during coronary artery bypass graft surgery in patients with ischaemic heart dysfunction †

Ryckwaert

Colson

Ribstein

et al. 2001

British Journal of Anaesthesia

View full text Add to dashboard Cite

Renal dysfunction occurring after open heart surgery is multifactorial in origin but activation of the renin-angiotensin system may have a prominent role. Fourteen patients with ischaemic heart dysfunction scheduled for elective coronary artery bypass graft (CABG) surgery were allocated to a treatment group [enalaprilat for 2 days; ACEI (angiotensin-converting enzyme inhibitor) group, n=7] or a control group (n=7). The cardiac index was significantly higher in ACEI-treated patients than in the controls before and after cardiopulmonary bypass (CPB) (P<0.05) and on postoperative day 2 (P<0.05). The systemic vascular resistance was significantly lower in the ACEI-treated patients than in the controls before and after CPB (P<0.05). Renal plasma flow, measured as [131I]orthoiodohippuran clearance (ClH), was higher in the ACEI group than in the control group before CPB, as was endogenous creatinine clearance after CPB (P<0.05). On post-operative day 7, ClH was significantly higher in the ACEI group than in the control group (P<0.05). Plasma renin activity and vasopressin concentration increased in both groups during CPB (P<0.05). The study demonstrates that administration of an i.v. ACEI, enalaprilat, improves cardiac output during CABG surgery in patients with ischaemic heart dysfunction. Moreover, renal perfusion was better maintained during surgery, and this effect was sustained up to post-operative day 7.

show abstract

Effect of acute angiotensin converting enzyme inhibition on left ventricular diastolic filling in patients with congestive heart failure: Relation to right ventricular volume

Cited by 12 publications

References 0 publications

Cardiorespiratory effects of continuous i.v. administration of the ACE inhibitor enalaprilat in the critically ill.

Cardiorespiratory effects of continuous i.v. administration of the ACE inhibitor enalaprilat in the critically ill.

The forgotten chamber: The importance of the right ventricle

Haemodynamic and renal effects of intravenous enalaprilat during coronary artery bypass graft surgery in patients with ischaemic heart dysfunction †

Contact Info

Product

Resources

About