Morgera T, Humar F, Mestroni L, Maras P, Camerini F
G Ital Cardiol. 1983;13(1):39-46.
Acute and chronic effects of captopril (C) were studied in 14 patients (12 males, 2 females; mean age 56 +/- 15 years) with chronic congestive heart failure (CCHF) refractory to digitalis and diuretics. All patients underwent hemodynamic evaluation before and after increasing doses of C (6.25-100 mg). Nine patients were evaluated during long term therapy by means of clinical examination, exercise testing, chest-X-ray and echocardiography. After C the following acute haemodynamic changes were observed. Mean right atrial pressure: -25% (p less than 0.01), left ventricular filling pressure: -22% (p less than 0.01), mean systemic arterial pressure: -15% (p less than 0.01), systemic vascular resistance: -31% (p less than 0.01), cardiac index: +36% (p less than 0.01). Of the 9 patients who were evaluated during long term C treatment, 7 (group A, mean follow up 6.4 +/- 4.2 months) improved in 1 or 2 NYHA functional classes and showed an increased exercise tolerance during the first 3-6 months of therapy. In this period, however, two sudden deaths and one drop-out were observed. Moreover, after the seventh month two patients of this group deteriorated clinically. Two patients (group B) developed a progressively weight gain during the first 15 days of C treatment. In the majority of our patients with refractory CCHF, captopril improves cardiac performance in the acute phase and in the first 3-6 months of therapy. Controlled studies and longer follow up are needed to understand better the long term effects of C in CCHF patients.
在14例（12例男性，2例女性；平均年龄56±15岁）对洋地黄和利尿剂治疗无效的慢性充血性心力衰竭（CCHF）患者中研究了卡托普利（C）的急性和慢性效应。所有患者在递增剂量的C（6.25 - 100mg）前后均接受了血流动力学评估。9例患者在长期治疗期间通过临床检查、运动试验、胸部X线和超声心动图进行评估。给予C后观察到以下急性血流动力学变化。平均右心房压：-25%（p＜0.01），左心室充盈压：-22%（p＜0.01），平均体动脉压：-15%（p＜0.01），体循环血管阻力：-31%（p＜0.01），心脏指数：+36%（p＜0.01）。在9例接受长期C治疗评估的患者中，7例（A组，平均随访6.4±4.2个月）在1或2个纽约心脏协会（NYHA）心功能分级上有所改善，并且在治疗的前3 - 6个月运动耐量增加。然而，在此期间观察到2例猝死和1例退出研究。此外，在第7个月后，该组中的2例患者临床病情恶化。2例患者（B组）在C治疗的前15天体重逐渐增加。在大多数难治性CCHF患者中，卡托普利在急性期和治疗的前3 - 6个月可改善心脏功能。需要进行对照研究和更长时间的随访以更好地了解C对CCHF患者的长期影响。
