Enalapril Reduces QTc Dispersion in Mild Congestive Heart Failure Secondary to Coronary Artery Disease
Section snippets
Methods
Forty-one patients (38 men and 3 women, mean [± SD] age 66 ± 8 years) with New York Heart Association class I to II CHF (few or no symptoms), and with echocardiographic evidence of left ventricular systolic dysfunction and left ventricular ejection fraction >35%, were identified from the heart failure clinic of our institution. All patients had evidence of coronary artery disease.
Patients were consecutive eligible patients attending the cardiac failure clinic of our institute with left
Results
Patient's demographic and baseline echocardiographic, renal, and laboratory characteristics are listed in Table 1, Table 2. There were no significant differences between the groups with respect to these measures.
Study medication was well tolerated by most patients. All but 2 patients tolerated dose titration. One patient withdrew during this period and one patient tolerated only the initial dose, both having orthostatic hypotension (enalapril-treated group). No serious drug-related adverse
Discussion
The most significant findings of this study relate to QTc dispersion. In our cohort of patients with early CHF, QTc dispersion was variable at baseline, with some patients already having markedly prolonged QTc dispersion even at this early stage of the disease. No obvious factor appeared to account for this marked variability. There is increasing evidence that prolonged QTc dispersion is a marker for sudden death in a number of conditions including CHF, peripheral vascular disease, and
Acknowledgements
This study was supported by Merck, Sharp & Dohme Hoddesdon, Herts, United Kingdom.
References (27)
- et al.
QT dispersion and sudden unexpected death in chronic heart failure
Lancet
(1994) - et al.
Utility of radioisotope filtration markers in chronic renal insufficiency: simultaneous comparison of 125I-iothalamate, 169yb-DTPA, 99 mTc-DTPA and inulin
Am J Kidney Dis
(1990) - et al.
Effectiveness of captopril in reversing renal vasoconstriction after Q wave acute myocardial infarction
Am J Cardiol
(1993) - et al.
Comparison of QT dispersion in hypertrophic cardiomyopathy between patients with and without ventricular arrhythmias and sudden death
Am J Cardiol
(1993) - et al.
ECG indexes of dispersion of ventricular repolarization: an isolated heart validation study
J Am Coll Cardiol
(1995) - et al.
The role of local disparity on conduction and recovery time on ventricular vulnerability to fibrillation
Am Heart J
(1977) - et al.
QT dispersion in nonsustained ventricular tachycardia and coronary artery disease
Am J Cardiol
(1996) - et al.
Effect of enalapril on myocardial infarction and unstable angina in patients with low ejection fractions
Lancet
(1992) - et al.
Blood levels of erythropoietin in congestive heart failure and correlation with clinical, hemodynamic and hormonal profiles
Am J Cardiol
(1994) - Ho KKL, Pinsky JL, Kannel WB, Levy D. The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol...
The prevalence of left ventricular dysfunction in North Glasgow (abstr)
Circulation
Plasma norepinephrine as a guide to prognosis in chronic congestive heart failure
N Engl J Med
Mechanism of death in patients with congestive cardiac failure: the change in plasma norepinephrine and its relation to sudden death
Cardioscience
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