Infusion of the ACE inhibitor teprotide significantly reduced systemic vascular resistance from 1619 to 1252 dyne-sec-cm-5 (P<0.001) in patients with severe chronic left ventricular failure.
Does infusion of the ACE inhibitor teprotide improve hemodynamics in patients with severe chronic left ventricular failure?
Acute ACE inhibition with teprotide significantly improves hemodynamics in severe chronic heart failure, particularly in patients with high baseline renin activity.
Absolute Event Rate: 1252% vs 1619%
p-value: p=<0.001
In 15 patients with severe chronic left ventricular failure, plasma renin activity (PRA) ranged widely, from 0.2--39 ng/ml/hr. The level of PRA was unrelated to cardiac output (CO) or pulmonary artery wedge pressure (PWP), but was slightly negatively correlated with mean arterial pressure (MAP) (r = -0.45) and systemic vascular resistance (SVR) (r = -0.40). After infusion of the angiotensin converting enzyme inhibitor teprotide (SQ 20,881) PWP fell from 26.3 +/- 1.3 (SEM) to 20.3 +/- 1.4 mm Hg (P less than 0.001), CO rose from 3.94 +/- 0.23 to 4.75 +/- 0.31 l/min (P less than 0.001), MAP fell from 87.5 +/- 3.8 to 77.9 +/- 4.1 mm Hg (P less than 0.001) and SVR from 1619 +/- 148 to 1252 +/- 137 dyne-sec-cm-5 (P less than 0.001). The fall in MAP and in SVR was significantly correlated with control PRA (r = 0.68 and r = 0.58, respectively). When subjects were divided on the basis of control PRA the hemodynamic response to teprotide was greatest in the high renin group. PRA rose after teprotide (8.7 +/- 3.4 to 37.9 +/- 7.7 ng/ml/hr, P less than 0.05) but plasma norepinephrine fell (619.1 +/- 103.6 to 449.7 +/- 75.7, P less than 0.05). The renin-angiotensin system thus appears to have an important role in the elevated SVR in some patients with heart failure. Chronic inhibition of converting enzyme should be explored as a possible therapeutic approach.
Curtiss et al. (1978) studied severe chronic left ventricular failure (n=15). teprotide (SQ 20,881) vs. baseline was evaluated on systemic vascular resistance (SVR) (p=<0.001). Infusion of the ACE inhibitor teprotide significantly reduced systemic vascular resistance from 1619 to 1252 dyne-sec-cm-5 (P<0.001) in patients with severe chronic left ventricular failure.