[Prognosis of mild chronic heart failure: effects of the ACE inhibitor captopril].

UNLABELLED

The Munich Mild Heart Failure Trial (MHFT) investigated the influences of ACE-inhibition on progression of congestive heart failure (CHF). Major end points were progression of CHF from New York Heart Association (NYHA) functional classes I to III to NYHA functional class IV despite optimal adjusted standard therapy and death due to congestive heart failure, i.e. death due to pump failure or sudden death. 170 patients were randomly assigned to treatment with either captopril (n = 83) 25 mg b.i.d. or placebo in addition to standard therapy for a median observation period of 2.7 years. The major result of this trial was the decrease in the relative risk for progressive heart failure by captopril therapy to 34% (95% confidence interval 17 to 68%; p = 0.01). Though total mortality was not reduced, death due to pump failure was found considerably less often on captopril than on placebo (18.2 vs 50% of total deaths in each group). In addition this report describes influences of captopril therapy on left ventricular size and function, heart size on X-ray, influences on symptomatology, electrolytes, ventricular arrhythmias, on concomitant therapy as well as effects in various subgroups. The major finding of the trial--the influence on progression of CHF--was independent of the underlying cardiac disease and was consistent in subgroups with different etiology of heart failure. Captopril blunted the increase in norepinephrine levels usually seen with increasing severity of congestive heart failure. There was a significant increase in serum sodium and potassium levels in the captopril treated group. Left ventricular size and function were well preserved in the patients still on randomized therapy after two years. No effects of therapy on ventricular ectopic activity were found in a subgroup of 93 patients that had had Holter monitoring.

IN CONCLUSION

Captopril has marked effects on progression of disease and reduces the likelihood of progressive heart failure in patients with mild symptoms. Several indices of unfavourable prognosis are either improved (sodium, norepinephrine, angiotensin II) or stabilized (left ventricular function). Thus ACE-inhibitors are to be considered for all patients requiring medical therapy for congestive heart failure.