[Hemodynamic effects of oral captopril in patients with critical aortic stenosis].

OBJECTIVES

To analyse the hemodynamic and ventricular function effects of oral captopril in severe aortic stenosis.

PATIENT POPULATION

inclusion criteria: patients older than 18 years with critical aortic stenosis.

EXCLUSION CRITERIA

angiotensin-converting enzyme inhibitor used previously contraindication to right catheterisation aortic insufficiency, valvular prosthesis in aortic position, or other valvulopathy. As well as the need for immediate valvular aortic replacement arrhythmia, A-V conduction alterations, or ventilatory support.

PROTOCOL

prospective, no randomized. Swan-Ganz catheter was used. Basal hemodynamic measurements were made on 1, 2, 4, 6 and 8 hours during 48 hours. Captopril was administered 12.5 mg first and then 8 mg tid (6 doses).

STATISTICAL ANALYSIS

Neuman-Keuls test was used for multivariate comparisons. Statistical significance was determined with P < 0.05.

RESULTS

22 patients were analyzed. Systemic vascular resistance fell from 1750 Dyn/seg/cm-5 to 1200 (P-0.001), cardiac output increased from 4.1l/min to 5.8 (P-0.001), cardiac index increased from 2.4 l/min/m2 to 2.9 (P-0.009), stroke volume from 47 ml to 64 (P-0.04) and stroke volume index from 27 ml/m2 to 36 (P-0.002). In patients with heart failure (n = 7) the systemic vascular resistance fell from 2050 Dyn/seg/cm-5 to 1463 (P-0.04), cardiac output increased from 2.8l/min to 4.1 (P-0.04), cardiac index from 2.07 l/min/m2 to 2.75 (P-0.04), stroke volume from 46 ml to 64 (P-0.03), pulmonary capillary wedge pressure fell from 19 mmHg to 16 (0.04) and the systolic pulmonary arterial pressure fell from 63 mmHg to 42 (P-0.009).

CONCLUSIONS

captopril improves the hemodynamic parameters in patients with critical aortic stenosis, principally in those with heart failure.