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PubMedDate not supplied

Echocardiographic evaluation of young adults with nonhemorrhagic cerebral infarction.

We reviewed echocardiographic findings in patients aged 15 to 45 years with acute nonhemorrhagic cerebral infarction (NHCI). Among 132 patients with NHCI, 96 (72.7%) had M-mode and two-dimensional echocardiography, including contrast echocardiography with intravenous saline injection when clinically indicated. Echocardiograms were abnormal in 33 patients. Of these, 7 had other conditions that could cause NHCI. Echocardiography corroborated the clinical diagnosis of a cardiogenic source for cerebral infarction in 17 others. The other 9 had no other clues for cardiovascular disease. Potential etiologies of NHCI diagnosed by echocardiography in these 9 cases included: paradoxical embolism, 5 patients; right atrial myxoma, 1; rheumatic mitral valve vegetation, 1; myxomatous mitral valve (marantic endocarditis at postmortem), 1; and left atrial enlargement associated with decreased left ventricular function, 1. Routine echocardiography frequently conveys useful information in patients under age 45 with NHCI. In young patients with cerebral embolism of unknown etiology if routine M-mode and two dimensional echocardiographic studies are normal, contrast echocardiographic studies should be performed to rule out intracardiac shunts and the possibility of paradoxical cerebral embolism.

Adolescent↗

PubMed1999

What are the predictors of restoration of sinus rhythm after combined treatment with surgical repair for organic heart disease and the Maze procedure for atrial fibrillation?

BACKGROUND: Recently, combined treatment using the Maze procedure for organic heart disease and atrial fibrillation has been reported, but there have been few studies of cardiac rhythm after combined treatment. Predictors of cardiac rhythm after combined surgical treatment have been unknown. METHODS: Thirty patients who underwent cardiac surgery with the Maze procedure were retrospectively enrolled in this study. Two groups consisted of the patients with restoration of sinus rhythm after surgery (SR: n=15, 6 males and 9 females, mean age of 64 years), and the patients with maintenance of atrial fibrillation (AF; n=15, 5 males and 10 females, mean age of 61 years). Before cardiac surgery, all patients underwent exercise testing with measurement of atrial natriuretic peptide (ANP) before and after exercise testing, two-dimensional echocardiography, and right and left heart catheterization. RESULTS: The mean maximal heart rate and the ANP level after exercise testing in SR were significantly higher than those in AF. The left atrial dimension and right atrial and pulmonary capillary wedge pressures were significantly higher in AF than in SR. These findings indicate that subjects in SR exhibited less impaired atrial function which were evaluated by exercise testing with measurement of ANP, echocardiography, and cardiac catheterization. CONCLUSIONS: The atrial function of patients with sinus rhythm after the Maze procedure may be less impaired than that of patients remaining in atrial fibrillation.

Aged↗

PubMed1975

[Hemodynamic evaluation of cardiac insufficiency in the acute stage of myocardial infarct].

In 70 patients hemodynamic controls were preformed during the first 4 days after acute myocardial infarction. A sufficient regulation of heart function and the circulation at rest was accepted with the following conditions: pulmonary artery wedge pressure less than or equal to 13mm Hg, mean right atrial pressure less than or equal to 6 mm Hg, mean systemic arterial pressure greater than 70 mm Hg, cardiac index greater than 2.51/min/m2 and stroke index greater than 25 ml/m2. In 88% of the patients with acute myocardial infarction a cardiac failure was present at rest. The pressures in the right atrium and left atrium (from wedge pressures) were elevated and cardiac output was reduced. The ratio of stroke work index/mean pulmonary artery wedge pressure allowed a more precise differentiation between a compensated and failing heart (X +/- S = 3.6 +/- 0.7 resp. 1.7 +/- 0.6 g m/m2 mm Hg). In the average, a significant improvement of the hemodynamic alterations, due or not due to therapy, occurred only at the 3rd day or later. In the individual case, this improvement points to a favorable prognosis.

Adult↗

PubMed2003

[Biventricular cardiac pacing].

Chronic heart failure (CHF) is a very frequent condition. Its frequency increases with prolongation of median life expectancy and due to improvements in medical care. However, medical treatment does not allow adequate control of symptoms in many cases. Therefore, various nonpharmacological approaches are being developed. The so-called biventricular pacing is one of them. Its main goal is to restore impaired mechanical cardiac synchrony that is present in patients with prolonged QRS duration due to inter- or intraventricular conduction abnormality. At present, biventricular pacing can be achieved through positioning of a special pacing lead into a branch of the coronary sinus on the surface of the left ventricle and implanting the other lead into the right ventricular cavity, and the third lead into right atrial appendage. Clinical trials and experience from many centres have documented improvements in clinical status in the vast majority of patients. An improvement in functional classification (NYHA) by at least one class, prolongation of the six minute walk distance by 20-40%, increase the maximal oxygen uptake by 10-40% a beneficial effect on quality of life can be expected. Preliminary results of the COMPANION trial have suggested that cardiac resynchronization therapy is associated with prognostic effect, especially in conjunction with implantable cardioverter-defibrillator.

Cardiac Output, Low↗

PubMed2003

Diagnostic and therapeutic utility of B-type natriuretic peptide in patients with renal insufficiency and decompensated heart failure.

Chronic kidney disease (CKD) and congestive heart failure (CHF) are epidemiologically and pathophysiologically linked. A recent study in patients with severe CHF demonstrated that renal plasma flow was inversely correlated with pulmonary capillary wedge pressure, right atrial pressure, pulmonary pressure, and right ventricular ejection fraction. This article reviews the utility of B-type natriuretic peptide (BNP) levels in assessing cardiac function and volume status in patients with CKD and examines the safety and efficacy of BNP therapy in patients with renal insufficiency and decompensated heart failure.

Clinical Trials as Topic↗

PubMed2004

Diagnostic and therapeutic utility of B-type natriuretic peptide in patients with renal insufficiency and decompensated heart failure.

Animals↗

PubMed2005

[DDD pacemaker implantation during atrial fibrillation in a patient with persistent left superior vena cava].

The case of 65-year-old male patient who underwent DDD pacemaker implantation due to symptomatic tachy-brady syndrome with first degree AV block is presented. During the procedure a paroxysmal atrial fibrillation occured and the presence of persistent left superior vena cava (PLSVC) was diagnosed. The "straight" passive fixation leads were introduced through the PLSVC and placed in the right atrium and ventricle, using curved stylets. Atrial lead implantation during atrial fibrillation is discussed. At three month, a follow-up revealed normal DDD pacemaker function.

Aged↗

PubMed1990

[Suppression of the immediate pressive response to unilateral nephrectomy by atrial natriuretic peptide in the rat].

Unilateral nephrectomy (UNX) is associated with an immediate and transient increase in arterial pressure and in prompt natriuresis from the remaining kidney. The hypothesis that atrial natriuretic peptide (ANP) is involved in the acute adaptation to unilateral nephrectomy was tested in euvolemic anesthetized Sprague-Dawley rats. In a first series of experiments, an increase in circulating ir-ANP levels (from 23.5 +/- 3.6 to 66.3 +/- 12.8 fmol/ml; p less than 0.01) was found within 2 minutes following renal exclusion. In a second set of experiments, the ANP response was inhibited by performing a right atrial appendectomy, in order to eliminate the major source of ANP, or by intravenous administration of monoclonal antibodies directed against ANP. When UNX was performed in the control groups (sham atrial appendectomy and administration of non specific monoclonal antibodies), mean arterial pressure rose immediately (maximal about 12% within 4 minutes) and transiently (return to pre-UNX values within 20 minutes) after UNX. At the same time, central venous pressure, monitored in the right atrium, tended to decrease slightly. In rats pretreated by right atrial appendectomy or by monoclonal antibodies directed against ANP, arterial pressure increased to the same extent as observed in control groups; this increase however was significantly more prolonged. In control groups, urinary cGMP excretion, the biological marker of ANP, increased twofold in parallel with the natriuretic response. These two responses were blunted in right atrial appendectomized rats and in rats receiving antibodies against-ANP. These results suggest that atrial natriuretic peptide plays a major role in the immediate functional adaptation to unilateral nephrectomy by blunting the increase in blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1987

[Pulsed Doppler echocardiographic findings in 117 professional cyclists].

To investigate the effect of long-term athletic training on the heart, pulsed Doppler echocardiography was performed in 117 male professional cyclists (Group C: 20-59 years of age), and 40 age- and sex-matched untrained normal controls (Group N). According to age, the subjects in each group were categorized in two subgroups: 74 cyclists (Group CI), 20-39 years of age and 43 cyclists (Group CII), 40-59 years of age; 24 control subjects (Group NI), 20-39 years of age and 16 control subjects (Group NII), 40-59 years of age. The average durations as professional cyclists were eight years in Group CI and 29 years in Group CII. The ratios of pre-ejection period to ejection time (LV-PEP/ET, RV-PEP/ET) as obtained from Doppler flow velocity patterns of the left and right ventricles (LV, RV) were used as parameters of systolic function. The peak flow velocities during rapid filling (LV-R, RV-R) and atrial systole (LV-A, RV-A), and the ratio of A to R (LV-A/R, RV-A/R) were used as parameters of diastolic filling dynamics. The parameters of systolic function of both ventricles and those of diastolic filling dynamics of the RV did not differ between Group C and Group N, Group CI and Group NI, and Group CII and Group NII. Study of the diastolic filling dynamics of the LV disclosed that Group C had a significantly higher LV-A/R (p less than 0.05) than did Group N; therefore, no significant differences between Group CI and Group NI, and Group CII had a significantly lower LV-R (p less than 0.005) and a higher LV-A/R (p less than 0.005) than did Group NII. Twenty-four hour ambulatory ECG monitoring was performed for 49 cyclists. Thirty cyclists aged 20-39 years were categorized in two groups according to their LV-A/R values: eight cyclists (Group A) with the LV-A/R greater than the mean + SD value (0.69) in Group NI and 22 cyclists (Group B) with the LV-A/R lower than or equal to 0.69. Nineteen cyclists aged 40-59 years were separated into two groups according to the LV-A/R value: 11 cyclists (Group A) with the LV-A/R values greater than the mean + SD value (0.89) in Group NII, and eight cyclists (Group B) with the LV-A/R equal to or less than 0.89.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1994

[Atrial fibrillation and flutter: experimental and clinical electrophysiology].

Several early publications already provided indirect evidence that atrial fibrillation is due to multiple, simultaneously activated reentrant wavelets. However, direct proof of this "multiple wavelet hypothesis" could only be obtained by means of activation mapping, which was conducted more recently in experimental as well as clinical atrial fibrillation. The surgical techniques for the treatment of atrial fibrillation are based on the knowledge on the pathophysiology of the arrhythmia. Similarly, early studies already suggested single, large reentrant circuits as the mechanism underlying atrial flutter. It could be demonstrated that a surgical lesion between the superior and inferior vena cava provided the basis for stable reentry around this large anatomical obstacle. But not only anatomical, but also functional obstacles, may be found in the center of a reentrant circuit. In typical atrial flutter, a long arc of functional conduction block extends from the inferior to the superior vena cava. In atypical atrial flutter, the central obstacle may be found anywhere in the right or, less frequently, in the left atrium. These experimental findings are supported by the clinical observation that a lesion in the area between the inferior vena cava and the nearby AV ring reproducibly terminates typical atrial flutter.

Animals↗

PubMed1995

Changes of plasma beta-endorphin levels before and after percutaneous transvenous mitral commissurotomy in patients with mitral stenosis.

To clarify the contribution of left atrial pressure to the secretion of beta-endorphin, we have investigated the relation between plasma beta-endorphin levels and hemodynamic changes in 35 patients with mitral stenosis undergoing percutaneous transvenous mitral commissurotomy (PTMC). Before PTMC, plasma beta-endorphin levels obtained from the antecubital vein (28.91 +/- 5.59 pg/ml) and from the femoral vein (28.20 +/- 5.44 pg/ml) in the patients with mitral stenosis were significantly higher than those obtained from the antecubital vein in the healthy volunteers (22.59 +/- 3.86 pg/ml, n = 34, P < 0.001 for each). The levels of beta-endorphin in the femoral vein correlated well with the mean left atrial pressure (r = 0.777, P < 0.001) and the mean right atrial pressure (r = 0.450, P < 0.01) before the procedure. The antecubital venous levels of beta-endorphin in patients in New York Heart Association functional Classes II (26.45 +/- 5.39 pg/ml, n = 20) and III (32.20 +/- 4.02 pg/ml, n = 15) were significantly higher than those in control subjects (P < 0.005 and P < 0.001, respectively). The differences between Classes II and III were significant (P < 0.001). The plasma levels of beta-endorphin in the patients complicated with atrial fibrillation were also significantly higher than those in patients with normal sinus rhythm (33.31 +/- 3.22 pg/ml, n = 13 vs 26.32 +/- 5.07 pg/ml, n = 22, P < 0.001). In ten to fifteen minutes after commissurotomy, plasma levels of beta-endorphin in the femoral vein significantly increased from 28.20 +/- 5.44 to 33.14 +/- 5.72 pg/ml (P < 0.001). In seventy-two hours after the procedure, plasma beta-endorphin levels in the antecubital vein fell to 24.37 +/- 2.59 pg/ml (P < 0.001 vs before PTMC and P < 0.05 vs control subjects). Plasma beta-endorphin levels in the patients with atrial fibrillation (26.62 +/- 2.36 pg/ml, P < 0.001 vs before PTMC and P < 0.002 vs control subjects) were still higher (P < 0.001) than those in patients with normal sinus rhythm (23.05 +/- 1.65 pg/ml, P < 0.001 vs before PTMC and P > 0.50 vs control subjects. There was a significant correlation between the levels of beta-endorphin in the antecubital vein and heart rate (r = 0.502, P < 0.001), mean transmitral pressure gradient (r = 0.543, P < 0.001) or mitral valve area (r = -0.710, P < 0.001) before and 72 hours after the procedure.

Adolescent↗

PubMed1987

Response of the mediastinal and thoracic viscera of the dog to intraoperative radiation therapy (IORT).

IORT may be a potentially useful adjunctive treatment combined with surgery and/or external beam irradiation in treating locally advanced lung and esophageal tumors. To begin investigation of this modality, the tolerance of intact mediastinal structures to IORT was studied using adult American Foxhounds (wt. 25-30 kg). Groups of six animals received IORT to doses of 20, 30, or 40 Gy to two separate intrathoracic ports, using 9 MeV electrons to treat a portion of the collapsed right upper lobe, and 12 MeV electrons to treat the mediastinal structures. A group of three dogs received thoracotomy with sham irradiation. Two dogs from each treatment dose group, as well as one sham-irradiated control, were sacrificed electively at 1, 3, and 12 months following IORT. There were no acute nor late IORT related mortalities. Post-operative weight loss was minimal (average 4.5% of pre-operative weight) for all dogs. Serial esophagrams showed no inflammation or ulceration. No cardiac nor pulmonary changes were noted clinically. At autopsy, the irradiated lung showed evidence of acute pneumonitis at 1 month with progressive fibrosis at 3 months and 1 year. Esophageal reactions were minimal, with only two dogs (one 30 Gy and one 40 Gy) demonstrating histologically confirmed esophagitis at 1 month. Tracheal changes were minimal. Cardiac damage was evident in the right atrial tissues. In several dogs, this cardiac damage ranged from myocardial vascular changes to frank ischemic necrosis noted at 1 and 3 months, and dense fibrosis at 1 year. The phrenic nerves showed normal function, but had evidence of perineural fibrosis. The large vessels demonstrated only mild histologic evidence of irradiation. The results of this large animal study suggest that intact mediastinal structures will tolerate small volume IORT to doses of 20 Gy without significant clinical sequellae. Although the histologic changes in the right atrium and contralateral lung are worrisome, no cardiac nor pulmonary problems arose over the 1 year follow-up. Irradiation of the contralateral lung and other sensitive structures can be reduced by careful selection of electron beam energy and use of custom lead shielding.

Animals↗

PubMed2001

Early and medium term results of tailored therapy for heart failure.

UNLABELLED: Patients (pts) with advanced chronic heart failure, in NYHA functional class IV, refractory to conventional medical therapy, show a poor short-term survival prognosis. Heart transplant remains the therapy of choice but it can currently be performed in only a minority of pts. Therapy tailored to hemodynamic goals has been suggested as a potential alternative for patients with advanced congestive heart failure. Intravenous and, subsequently, oral vasodilators (v) and diuretics (d) are titrated, in order to achieve specific hemodynamic parameters: systolic arterial pressure (SAP) > 80 mmHg, pulmonary wedge pressure (PWP) < 15 mmHg, right atrial pressure (RAP) < 8 mmHg, and systemic vascular resistance (SVR) < 1200 dynes.sec.cm-5. AIM: To assess short and medium term (two years) results of a tailored therapy management program for treatment of patients with advanced heart failure. METHODS: 27 pts (19 males, 61 +/- 10 years), NYHA functional class IV, with dilated cardiomyopathy (13 idiopathic, 10 ischemic, 4 hypertensive), 17 with exclusion criteria for heart transplantation, were included. Echocardiographic left ventricular end-diastolic dimension and ejection fraction were 68 +/- 8 mm and 20 +/- 9%, respectively. Initial (i) serum sodium (Na+) was 136 +/- 5 mEq/l and i serum creatinine (Cr) was 1.4 +/- 0.8 mg/dl. Baseline, at referral, hemodynamics: SAP = 125 +/- 23, PWP = 23 +/- 6, RAP = 12 +/- 6, cardiac index (CI) = 1.9 +/- 0.5 l/min/m2, SVR = 2193 +/- 670. Using bedside right heart catheterization (Swan-Ganz catheter) we set out to achieve the above hemodynamic goals. RESULTS: 1) v and d used: sodium nitroprusside--cumulative dose = 196 +/- 121 mg, captopril--daily dose (dd) = 157 +/- 95 mg, isosorbide dinitrate--dd = 91 +/- 57 mg, hydralazine--dd = 95 +/- 67 mg, and furosemide--dd = 105 +/- 70 mg; 2) final (f) hemodynamic parameters on tailored therapy: SAP = 109 +/- 20*, PWP = 12 +/- 3*, RAP = 4 +/- 3*, CI = 2.5 +/- 0.6*, SVR = 1317 +/- 340* (*: p < 0.001 vs baseline); 3) duration of invasive monitoring was 3.0 +/- 1.9 days; 4) f Na+ = 134 +/- 5, and f Cr = 1.5 +/- 0.8 (NS vs i); 5) there was one (4%) in-hospital death; functional class of discharged pts: III--4 pts, II--18 pts, I--4 pts; 6) nine pts (35%) died after discharge--three due to refractory heart failure and six (including two potential heart transplant candidates) had sudden death; 7) actuarial survival (Kaplan-Meyer method): at 6 months (m)--80%, 12 m--71%, 18 m--64%, 24 m--55%; 8) after a mean follow-up of 18 +/- 8 m, functional class in survivors was: NYHA IV--2 pts, III--4 pts, II--8 pts, and I--3 pts. CONCLUSIONS: Therapy tailored to hemodynamic goals is a valid approach for pts with advanced heart failure, showing good hemodynamic and functional short-term results, and reasonable survival at two years. The significant incidence of sudden death demands strategies for risk stratification and a search for prophylactic measures in this population.

Female↗

PubMed1999

Evaluation of left ventricular diastolic function when mitral E and A waves are completely fused: role of assessing mitral annulus velocity.

Mitral inflow parameters have been used most widely in the evaluation of left ventricular (LV) diastolic function. However, when the mitral E and A waves are completely fused, mitral inflow parameters cannot provide information about the LV diastolic function. LV filling pressure, mitral inflow, mitral annulus velocity, and tau (tau) were measured in 59 patients with sinus rhythm when mitral E and A waves were completely fused with right atrial pacing. When mitral E and A waves were completely fused, tau correlated with the peak fused mitral annulus velocity (r = -0.60, P <.001), and peak fused mitral annulus velocity of less than 12.5 cm/s best discriminated prolonged (>/=50 ms) from normal tau, with a sensitivity of 78% and specificity of 69%. The peak fused mitral inflow velocity to peak fused mitral annulus velocity ratio correlated with LV filling pressure (r = 0.62, P <.001). A ratio of at least 8, could predict elevated LV filling pressure (>/=15 mm Hg) with a sensitivity of 65% and specificity of 74%. In conclusion, even when mitral E and A waves are completely fused, mitral annulus velocity can be used in the evaluation of LV diastolic function.

Cardiac Catheterization↗

PubMed1993

Different stroke volumes for the left and right ventricles in the moving-actuator type total artificial heart.

A new electromechanical moving-actuator type total artificial heart (TAH) has been developed to solve the imbalance problem without an extra compliance chamber. A different stroke volume was achieved by the large left sac size and the asymmetry of the actuator motion referred to the center position. The left ventricle consists of a double sac with the outer sac attached to the actuator providing active diastolic filling, while the double sac of the right ventricle being free from the actuator, and having sufficient suction produced due to the rigid pump housing. The stroke volume difference between the left and right sac is compensated through the air in the interventricular space of the variable volume (VV) space. Computer simulation based on the geometrical relationships between the blood sacs and the actuator was performed to simulate the physical mechanisms of the moving-actuator type TAH. Results were then compared with the measured pressure changes in various chambers of the pump and the stroke volume differences in mock circulation test. In two acute calf experiments, the balanced left and right atrial pressures were achieved in the moving-actuator type TAH without an extra compliance chamber.

Animals↗

PubMed1991

Long-term results after atrial correction of complete transposition of the great arteries.

This study presents the late results for the first 104 consecutive patients surviving and atrial repair for transposition of the great arteries (TGA) between January 1971 and December 1978 (group 1). Mean follow-up was 12 years (range, 0.1 to 17.7 years). The actuarial survival rate at 18 years was 84.2% (70% confidence limits, 79% to 88%) for simple TGA and 93.7% (70% confidence limits, 84% to 97%) for complex TGA. Nine of the 11 deaths were sudden. Two (2.6%) of the 78 late survivors operated on for simple TGA are in New York Heart Association functional class III or IV versus 4 (26.7%) of the 15 survivors with complex TGA; the other patients are doing very well. To better assess long-term results, we report the findings for randomly obtained electrocardiograms, Holter monitor recordings, radionuclide angiographic studies, and cardiac catheterizations performed in 1987 in a larger group of 159 long-term survivors of atrial repair operated on at Ospedale Riuniti di Bergamo from January 1971 to December 1984 (group 2), which includes all of group 1. The findings confirm that the arterial switch repair is the procedure of choice for complex TGA and that there is a major incidence (approximately 10%) of systemic right ventricular dysfunction and rhythm disturbances after the atrial repair. On the other hand, our late survival rate at 18 years of 84% for simple TGA with 97.5% of the patients in functional class I is a result that should be kept in mind, especially in institutions where the arterial switch is a relatively new approach and presumably is a higher risk to cause early death.

Cardiac Catheterization↗

PubMed1995

[Studies on atrial arrhythmias in atrial septal defect. The influences of aging on atrial fibrillation].

Clinical characteristics of aging in congenital atrial septal defect (ASD) without significant right-to-left shunt (> 10%), were examined especially focusing on atrial arrhythmias such as atrial fibrillation (Af) and atrial premature contraction (PAC) in serial 48 patients, aged 42.6 +/- 2.3, ranging 16-67 years, Af was found in 12 (25%) out of 48 patients. Comparing patients with Af and those without Af, the average age (52.8 +/- 2.6 vs 38.6 +/- 2.8 years, p < 0.05), functional class of New York Heart Association (2.0 +/- 0.2 vs 1.6 +/- 0.1, p < 0.05) and left atrial dimension (41.4 +/- 1.1 vs 34.7 +/- 1.2 mm, p < 0.01) were significantly higher in the patients with Af than those without Af. Hemodynamic variables, i.e., mean right or left atrial pressure, Pp/Ps, Qp/Qs, left-to-right shunt, electrocardiographic R/S ratio in the lead V1 and tricuspid regurgitation had no relation either with aging or Af. Furthermore, daily PAC counts on Holter electrocardiograms significantly correlated with the age of the patients (r = 0.642, p < 0.05). These results suggest that the incidence of Af in congenital ASD is significantly related with aging/duration of ASD, but not with hemodynamic variables.

Adolescent↗

PubMed1988

Modulation of hemodynamic effects with a converting enzyme inhibitor: acute hemodynamic dose-response relationship of a new angiotensin converting enzyme inhibitor, lisinopril, with observations on long-term clinical, functional, and biochemical responses.

The hemodynamic effects of varying oral doses of the long-acting converting enzyme inhibitor lisinopril were studied in an acute, single-blind, parallel fashion in 55 patients with moderate to severe congestive heart failure. Doses of 2.5, 5.0, and 10 mg produced a significant increase in cardiac index and significant reductions in pulmonary capillary wedge, right atrial, pulmonary arterial, and systemic arterial pressures and systemic vascular resistance. The changes were present up to 24 hours after dosing for most parameters. There was a clear-cut dose-response relationship observed. Forty-seven patients were followed over a 3-month period, during which functional status and exercise tolerance improved. Although 26% showed some evidence of renal dysfunction with lisinopril, these changes could be normalized by decreasing either the lisinopril or the diuretic dose. These data demonstrate that the hemodynamic changes with the long-acting converting enzyme inhibitor lisinopril can be modulated with dose adjustment in patients with congestive heart failure. They also suggest that renal function changes may be normalized by adjustment of either the dose of lisinopril or the diuretic dose.

Angiotensin-Converting Enzyme Inhibitors↗