Key result
Intravenous enalaprilat (0.004 mg/kg) decreased mean arterial pressure (P<0.001) and pulmonary artery occlusion pressure (P<0.001), with continuous infusion prolonging the effect versus bolus.
Why the study?
Does continuous 1-hour infusion of low-dose enalaprilat improve hemodynamics and systemic oxygenation compared to bolus administration in patients with acute refractory decompensated heart failure?
Does continuous 1-hour infusion of low-dose enalaprilat improve hemodynamics and systemic oxygenation compared to bolus administration in patients with acute refractory decompensated heart failure?
Low-dose intravenous enalaprilat safely improves hemodynamics in acute refractory decompensated heart failure, with continuous infusion providing more prolonged effects than bolus administration.
Answers are grounded in this paper and cite their sources.
May support short-term hemodynamic stabilization with low-dose IV enalaprilat in refractory HF; hypothesis-generating for continuous infusion benefit pending RCTs.
The first dose of angiotensin-converting enzyme (ACE) inhibitors may trigger a considerable fall of blood pressure in chronic heart failure. The response may be dose-related. To determine hemodynamic and systemic oxygenation effects of low-dose enalaprilat, we administered intravenous enalaprilat (0.004 mg/kg) as bolus (group B) or continuous 1-hour infusion (group C) in 20 patients with congestive heart failure due to ischemic heart disease with acute decompensation refractory to inotropic, vasodilator and diuretic therapy. Hemodynamic and systemic oxygenation variables were recorded at baseline (+0 min), +30, +60, +120, +180, and +360 min after the start of intervention. Mean arterial pressure (MAP) (p < 0. 001), mean pulmonary artery pressure (MPAP) (p < 0.001), pulmonary artery occlusion pressure (PAOP) (p < 0.001), oxygen extraction ratio (ER) (p < 0.026) decreased regardless of enalaprilat application. Compared to group B, there was in group C prolonged decrease of MAP, MPAP, PAOP, ER and increase of pulmonary artery oxyhemoglobin saturation in regard to baseline values. Cardiac index, heart rate, central venous pressure and oxygen consumption index did not change. A low dose of intravenous enalaprilat (0.004 mg/kg) can be used to safely improve hemodynamics and systemic oxygenation in congestive heart failure due to ischemic heart disease with acute refractory decompensation.
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Podbregar et al. (1999) studied Congestive heart failure with acute refractory decompensation (n=20). Intravenous enalaprilat (continuous 1-hour infusion) vs. Intravenous enalaprilat (bolus) was evaluated on Hemodynamic and systemic oxygenation variables (MAP, MPAP, PAOP, ER) (p=<0.001). Intravenous enalaprilat (0.004 mg/kg) decreased mean arterial pressure (P<0.001) and pulmonary artery occlusion pressure (P<0.001), with continuous infusion prolonging the effect versus bolus.
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