Document Detail


Enalaprilat in acute intractable heart failure after myocardial infarction: a prospective, consecutive sample, before-after trial.
MedLine Citation:
PMID:  8205829     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the acute effects of intravenous enalaprilat infusion in critically ill patients with intractable heart failure after acute myocardial infarction. DESIGN: Prospective, consecutive sample, before-after trial. SETTING: Medical intensive care unit in a university hospital. PATIENTS: Eight consecutive patients with intractable acute heart failure after acute myocardial infarction. All study patients continued receiving inotropic, vasodilating, and diuretic medication at a constant rate. Six patients received steady intermittent mandatory ventilation and two patients were on a continuous positive airway pressure mask during the investigation, all with constant positive end-expiratory pressure. Heart failure was defined as intractable if the pulmonary artery occlusion pressure remained > 20 mm Hg despite this conventional therapy. INTERVENTIONS: Enalaprilat was infused at a rate of 1 mg/hr until the pulmonary artery occlusion pressure decreased by > or = 20%. MEASUREMENTS AND MAIN RESULTS: Central hemodynamics, oxygenation, and hormonal regulation (plasma renin activity, plasma norepinephrine, epinephrine, endothelin, atrial natriuretic peptide, and vasopressin concentrations, serum angiotensin-converting enzyme activity, and serum concentrations of aldosterone) were assessed at baseline before enalaprilat infusion, and repeatedly during 2 hrs after the infusion. The statistical analysis was performed with analysis of variance for repeated measurements. Enalaprilat infusion (median dose 0.3 mg and infusion time 21 mins) caused significant but short-lasting decreases in pulmonary artery occlusion pressure (p = .007), mean arterial pressure (p = .003), mean pulmonary arterial pressure, and rate pressure product. These findings coincided with inhibition of serum angiotensin-converting enzyme activity, an increase in plasma renin activity, and a decrease in plasma endothelin concentrations (p = .041). Enalaprilat had no significant effects on the other hormones studied. Cardiac output and stroke volume index, venous admixture, oxygen extraction ratio, and mixed venous and arterial oxygen saturations remained unchanged. CONCLUSIONS: Adding enalaprilat to conventional therapy makes it possible to transiently relieve pulmonary congestion while maintaining cardiac function and systemic oxygenation. The decrease in plasma endothelin concentrations may have further clinical implications, because endothelin is known to have potent vasoconstricting effects on the coronary circulation and it may also contribute to the extension of myocardial infarction. Whether these observed benefits can be maintained with repeated bolus injections or with continuous infusion of enalaprilat, remains to be settled.
Authors:
H Tohmo; M Karanko; K Korpilahti; M Scheinin; O Viinamäki; P Neuvonen
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  22     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  1994 Jun 
Date Detail:
Created Date:  1994-07-08     Completed Date:  1994-07-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  965-73     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Turku University Central Hospital, Finland.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Combined Modality Therapy
Enalaprilat / therapeutic use*
Female
Finland / epidemiology
Heart Failure / drug therapy*,  epidemiology,  etiology,  physiopathology
Hemodynamics / drug effects
Humans
Male
Middle Aged
Myocardial Infarction / complications,  drug therapy*,  epidemiology,  physiopathology
Prospective Studies
Statistics as Topic / methods
Time Factors
Chemical
Reg. No./Substance:
84680-54-6/Enalaprilat

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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