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Captopril in children with dilated cardiomyopathy: Acute and long-term effects in a prospective study of hemodynamic and hormonal effects

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Summary

Hemodynamic and hormonal effects of captopril were prospectively studied in 12 children (median age 5.8 years, range 4 weeks to 15 years) with dilated cardiomyopathy. A mean dose of 1.83 mg captopril/kg body weight was administered in three or four single doses depending on age.

Left ventricular volume, ejection fraction (EF), cardiac index (CI), and systemic vascular resistance (SVR) were noninvasively determined by two-dimensional (2D) and Doppler echocardiography before and 2 days and 3 months after the onset of treatment. Blood pressure and heart rate were recorded as well. Additionally, on the day hemodynamic measurements were made, plasma renin activity (PRA), serum aldosterone, and plasma atrial natriuretic peptide (ANP) concentrations were determined. Plasma catecholamines were measured before and 2 days after captopril treatment. Concomitant medication was kept constant during the short-term phase of captopril treatment. During long-term therapy, diuretics were reduced according to the clinical status. Stroke volume (SVI) (−7%), end-systolic (ESVI) (−31%), and enddiastolic (EDVI) (−21%) volume indexes were significantly reduced (p<0.05) during short-and long-term therapy. The remaining hemodynamic parameters showed only minor, statistically not significant, changes. During short-term therapy, median serum aldosterone levels fell from 138–88.5 pg/ml (p<0.05), and plasma ANP decreased from 144–94 pg/ml (p<0.05). After 3 months these effects were less marked and statistically no longer significant. Changes in PRA and plasma catecholamines were not statistically significant at any time.

Captopril thus exerted beneficial hemodynamic effects in these children with dilated cardiomyopathy by reducing left ventricular volume load. Acute hormonal drug effects were distinctly weakened during long-term therapy, while hemodynamic improvement was maintained.

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References

  1. Ader R, Chatterjee K, Ports T, Brundage B, Hiramatsu B, Parmley W (1980) Immediate and sustained hemodynamic and clinical improvement in chronic heart failure by an oral angiotensin-converting enzyme inhibitor.Circulation 61:931–937

    PubMed  Google Scholar 

  2. Arendt RM, Gerbes AL, Stangl E, Ritter D, Zähringer J, Schultheiß HP, Kemkes B, Erdmann E (1988) Tonische und phasische Aktivität des endokrinen Herzens bei kardiovaskulären Patienten und Patienten mit Leberzirrhose. In: Kreye VA, Bussmann WD (eds)ANP-atriales natriuretisches Peptid und das kardiovaskuläre System. Steinkopff Verlag. Darmstadt, pp 179–189

    Google Scholar 

  3. Awan N, Evenson M, Needham K (1981) Efficacy of oral angiotensin converting enzyme inhibition with captopril therapy in severe heart failure.Am Heart J 101:22–29

    Article  PubMed  Google Scholar 

  4. Bayer O, Loogen, F, Wolter HH (eds) (1967)Die Herzkatheterisierung bei angeborenen und erworbenen Herzfehlern, 2nd edn. Thieme Verlag, Stuttgart, p 57

    Google Scholar 

  5. Belz GG, Aust PE, Belz G, Apel E, Palm D (1982) Sympathomimetic effects of amezinium on the cardiovascular system and plasma catecholamines in man.Eur J Clin Pharmacol 23:15–20

    Article  PubMed  Google Scholar 

  6. Chapman C, Baker O, Reynolds J, Bonte F (1958) Use of biplane cinefluorography for measurement of ventricular volume.Circulation 18:1105–1117

    PubMed  Google Scholar 

  7. Cody RJ, Atlas SA, Laragh JH (1986) Atrial natriuretic factor in normal subjects and heart failure patients.J Clin Invest 78:1362–1374

    PubMed  Google Scholar 

  8. Cody R, Franklin K, Kluger J, Laragh J (1982) Sympathetic responsiveness and plasma norepinephrine during therapy of chronic congestive heart failure with captopril.Am J Cardiol 72:791–797

    Google Scholar 

  9. Cohn J, Archibald D, Ziesche S, Franciosa J, Harston W, Tristani F, Dunkman W, Jacobs W, Francis G, Flohr K, Goldman S, Cobb F, Shah P, Saunders R, Fletcher R, Loeb H, Hughes V, Baker B (1986) Effect of vasodilator therapy on mortality in chronic congestive heart failure: Results of a Veterans Administration Cooperative Study.New Engl J Med 314:1547–1552

    PubMed  Google Scholar 

  10. Consensus Trial Group Study (1987) Effects of enalapril on mortality in severe congestive heart failure.New Engl J Med 316:1429–1435

    Google Scholar 

  11. Craeger M, Halperin J, Bernard D, Faxon D, Melidossian C, Gavras H, Ryan TJ (1981) Acute regional circulatory and renal hemodynamic effects of converting enzyme inhibition in patients with congestive heart failure.Circulation 64:483–489

    PubMed  Google Scholar 

  12. Craeger M, Massie B, Faxon D, Friedman S, Kramer B, Weiner D, Ryan T, Topic N, Melidossian C (1985) Acute and longterm effects of enalapril on the cardiovascular response to exercise and exercise tolerance in patients with congestive heart failure.JACC 6:163–170

    PubMed  Google Scholar 

  13. Davis R, Ribner H, Keung E, Sonnenblick EH, LeJemtel TH (1979) Treatment of chronic congestive heart failure with captopril, an oral inhibitor of angiotensin converting enzyme.New Engl J Med 301:117–121

    PubMed  Google Scholar 

  14. Dillon MJ (1974) Renin and hypertension in childhood.Arch Dis Child 49:831–833

    PubMed  Google Scholar 

  15. Dillon M, Ryness J (1975) Plasma renin activity and aldosterone concentrations in children.Br Med J 4:316–319

    PubMed  Google Scholar 

  16. Dillon M, Gillin M, Ryness J, Swiet M (1976) Plasma renin activity and aldosterone concentrations in the human newborn.Arch Dis Child 51:537–540

    PubMed  Google Scholar 

  17. Dzau V, Colucci W, Williams G, Curfman G, Meggs L, Hollenberg N (1980) Sustained effectiveness of converting enzyme inhibition in patients with severe congestive heart failure.New Engl J Med 302:1373–1379

    PubMed  Google Scholar 

  18. Erbel R (1985) Funktionsdiagnostik des linken Ventrikels. In: Grube E (ed)Zweidimensionale Echokardiographie. G. Thieme Verlag. Stuttgart, New York, pp 347–360

    Google Scholar 

  19. Erbel R, Schweitzer P, Lambertz H, Henn G, Meyer J, Krebs W, Effert S (1983) Echoventriculography—A simultaneous analysis of two-dimensional echocardiography and cineventriculography.Circulation 67:205–215

    PubMed  Google Scholar 

  20. Faxon D, Creager M, Halperin J, Gavras H, Coffman J, Ryan TJ (1980) Central and peripheral hemodynamic effects of angiotensin inhibition in patients with refractory congestive heart failure.Circulation 61:925–930

    PubMed  Google Scholar 

  21. Faxon D, Halperin J, Craeger M, Gavras H, Schick E, Ryan TJ (1981) Angiotensin inhibition in severe heart failure: Acute central and limb hemodynamic effects of captopril with observation on sustained oral therapy.Am Heart J 101:548–556

    Article  PubMed  Google Scholar 

  22. Fouad F, Tarazi R, Bravo E, Hart N, Castle L, Salcedo E (1982) Longterm control of congestive heart failure with captopril.Am J Cardiol 49:1489–1496

    Article  PubMed  Google Scholar 

  23. Francis G (1985) Neurohormonal mechanism involved in congestive heart failure.Am J Cardiol 55:15A-21A

    Article  PubMed  Google Scholar 

  24. Gavras H, Faxon D, Berkoben J, Brunner HR, Ryan TJ (1978) Angiotensin converting enzyme inhibition in patients with congestive heart failure.Circulation 58:770–776

    PubMed  Google Scholar 

  25. Gerzer R, Weil J, Strom T (1985) Mechanisms of action of atrial natriuretic factor. Clinical consequences.Kli Wochenschr 64 (suppl VI):21–26

    Google Scholar 

  26. Goldberg S, Allen H, Marx G (1985)Doppler echocardiography. Lea & Feabinger, Philadelphia, pp 68–80

    Google Scholar 

  27. Gueret P, Corday E (1981) Étude quantitative de la function ventriculaire gauche par l'échocardiographie bidimensionelle.Arch Mal Coeur 74:329–336

    PubMed  Google Scholar 

  28. Kramer B, Massie B, Topic N (1983) Controlled trial of captopril in chronic heart failure: A rest and exercise hemodynamic study.Circulation 67:807–816

    PubMed  Google Scholar 

  29. Levine T, Franciosa J, Cohn J (1980) Acute and longterm response to an oral converting enzyme inhibitor, captopril, in congestive heart failure.Circulation 62:35–41

    PubMed  Google Scholar 

  30. Massie B, Kramer B, Topic N (1984) Lack of relationship between the shortterm hemodynamic effects of captopril and subsequent clinical responses.Circulation 69:1135–1141

    PubMed  Google Scholar 

  31. Massie B, Kramer B, Topic N, Henderson S (1982) Hemodynamic and radionuclide effects of acute captopril therapy for heart failure: Changes in left and right ventricular volumes and function at rest and during exercise.Circulation 65:1374–1381

    PubMed  Google Scholar 

  32. Meijboom E, Rijsterborgh H, Bot H, de Boo J, Roelandt J, Bom N (1987) Limits of reproducibility of blood flow measurements by echocardiography.Am J Cardiol 59:133–137

    Article  PubMed  Google Scholar 

  33. Mettauer B, Rouleau J, Bichet D, Kortas C, Manzini C, Tremblay G, Chatterjee K (1986) Differential long-term intrarenal and neurohormonal effects of captopril and prazosin in patients with chronic congestive heart failure: Importance of initial plasma renin activity.Circulation 79:492–502

    Google Scholar 

  34. Packer M (1985) Is the renin-angiotensin system really unnecessary in patients with severe chronic heart failure: The price we pay for evolution.JACC 6:171–173

    Google Scholar 

  35. Packer M, Lee W, Medina N, Yushak M (1985) Hemodynamic and clinical significance of the pulmonary vascular response to longterm captopril therapy in patients with severe chronic heart failure.JACC 6:635–645

    PubMed  Google Scholar 

  36. Pfeffer M, Lamas G, Vaughan D, Parisi A, Braunwald E (1988) Effect of captopril on progressive ventricular dilatation in anterior mycardial infarction.New Engl J Med 319:80–85

    PubMed  Google Scholar 

  37. Pilossoff V, Schöber JG, Peters D, Bühlmeyer K (1985) Non-invasive oscillometric measurements of systolic, mean and diastolic blood pressure in infants with congenital heart defects after operation. A comparison with direct blood pressure measurements.Eur J Pediatr 144:324–330

    Article  PubMed  Google Scholar 

  38. Sachs L (1984)Angewandte Statistik, 6th edn. Springer-Verlag, Berlin, Heidelberg, New York, Tokyo, p 201

    Google Scholar 

  39. Shaddy RE, Teitel DF, Brett C (1988) Shortterm hemodynamic effects of captopril in infants with congestive heart failure.AJDC 142:100–105

    PubMed  Google Scholar 

  40. Sharpe N, Murphy J, Coxon R, Hannan S (1984) Enalapril in patients with chronic heart failure: A placebo-controlled, randomized, double-blind study.Circulation 70:271–278

    PubMed  Google Scholar 

  41. Staessen J, Lijnen P, Fagard R, Verschueren J, Amery A (1981) Rise of plasma aldosterone during longterm captopril treatment.New Engl J Med 304:1110

    Google Scholar 

  42. Stern HC, Matthews JH, Belz GG (1984) Influence of dihydralazine induced afterload reduction on systolic time intervals and echocardiography in healthy subjects.Br Heart J 52:435–439

    PubMed  Google Scholar 

  43. Sulyok E, Nemeth M, Tenyi I (1979) Postnatal development of renin-angiotensin-aldosterone system, RAAS, in relation to electrolyte balance in premature infants.Pediatr Res 13:817–820

    PubMed  Google Scholar 

  44. Weil J, Bidlingmaier F, Döhlemann C, Kuhnle U, Strohm T, Lang R (1986) Comparison of plasma atrial natriuretic peptide levels in healthy children from birth to adolescence and in children with cardiac diseases.Pediatr Res 20:1328–1331

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute for Clinical Chemistry, Deutsches Herzzentrum München, München, FRG

    H. Stern, T. Genz, W. Vogt & K. Bühlmeyer

  2. Department of Pediatrics, Ludwig-Maximilian-Universität, München, FRG

    J. Weil

  3. Pediatric Cardiology, Deutsches Herzzentrum München, Lothstrasse 11, D-8000, München 2, FRG

    H. Stern, T. Genz, W. Vogt & K. Bühlmeyer

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Stern, H., Weil, J., Genz, T. et al. Captopril in children with dilated cardiomyopathy: Acute and long-term effects in a prospective study of hemodynamic and hormonal effects. Pediatr Cardiol 11, 22–28 (1990). https://doi.org/10.1007/BF02239543

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