ONE-YEAR CLINICAL AND ECHOCARDIOGRAPHIC FOLLOW-UP OF PATIENTS WITH CONGESTIVE CARDIOMYOPATHY TREATED WITH CAPTOPRIL COMPARED TO PLACEBO

The beneficial hemodynamic and clinical effects of angiotensin-convert ing enzyme (ACE) inhibition in patients with severe congestive heart f ailure has recently been documented in large-scale studies. This mode of therapy when added to digitalis and diuretics improves survival. To evaluate the clinical effect and the changes in cardiac dimensions of captopril compared to placebo we followed 50 patients with severe con gestive heart failure over 1 year using echo-Doppler cardiography. Aft er randomization, 25 patients were started on captopril and 25 patient s on placebo. At baseline and at 6 and 12 months, each patient underwe nt exercise tolerance test, radionuclide angiography to estimate left and right ventricular ejection fraction, M mode and two-dimensional ec hocardiography and Doppler cardiography to calculate cardiac dimension s and stroke volumes. During follow-up two patients in the captopril g roup and four in the placebo group died. Due to clinical deterioration nine patients in the placebo group had to be started on open-label ca ptopril. Treatment with captopril was associated with a more significa nt improvement in functional class and exercise duration compared to p lacebo. Forward stroke volume estimated from Doppler echocardiography increased significantly by captopril from 47 +/- 3 to 55 +/- 3 ml and decreased in the placebo-treated patients from 49 +/- 5 to 44 +/- 4 ml . This improvement was associated with a trend towards reduced heart r ate by captopril. Left ventricular end diastolic volume tended to incr ease in the placebo group and did not change in the captopril group. C alculated mitral regurgitant volume at 6 and 12 months tended to be lo wer in the captopril-treated patients. Thus captopril therapy proved e fficacious in patients with severe congestive heart failure and result ed in increased forward stroke volume; it may have a beneficial effect on cardiac dimensions and on mitral regurgitation.