| Popis: |
Although the introduction of angiotensin-converting enzyme (ACE) inhibitors in the treatment of congestive heart failure has led to improved management and outcome of the disease, the progression of ventricular dysfunction remains a major problem. The present study was designed to examine the long-term effects of felodipine, a calcium channel blocker, on the progression of ventricular dysfunction in patients with mild ischemic heart failure treated chronically with the ACE inhibitor enalapril. A total of 23 patients with a history of myocardial infarction and mild heart failure (New York Heart Association [NYHA] functional class I or II; mean ejection fraction, 30.5 ± 1.6%), who had received long-term treatment with enalapril 5 to 10 mg/d, were randomized to receive felodipine 5 mg/d (n = 12) or placebo (n = 11) for 12 months. At baseline, the study groups had similar hemodynamic and clinical characteristics as well as similar hormonal profiles. In contrast, during the study, ejection fraction decreased progressively from 30.1 ± 1.9% to 29.6 ± 1.9% in the placebo group but increased progressively from 30.8 ± 2.5% to 36.3 ± 2.1% in the felodipine group. Consistently, plasma atrial and brain natriuretic peptide levels were higher at 12 months in the placebo group than in the felodipine group. At baseline and at 12 months, 2 patients were in NYHA class I and 9 patients in class II in the placebo group; in the felodipine group, 4 patients were in class I and 8 patients in class II at baseline, and 7 patients in class I and 5 patients in class II at 12 months. Left ventricular adaptations to volume loading measured after 3 months of treatment were significantly improved only in the felodipine group. Similarly, peak oxygen consumption during cardiopulmonary testing increased significantly only in the felodipine group. These results show that the long-term addition of felodipine to treatment with ACE inhibitors significantly improves ventricular function and may reduce the progression of disease in patients with mild ischemic heart failure. |
