Alexander Jobs1,2,3, Amr Abdin4, Suzanne de Waha-Thiele5,6, Ingo Eitel5,6, Holger Thiele7, Cor de Wit6,8, Reinhard Vonthein9. 1. Medizinische Klinik II/Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. alexander.jobs@medizin.uni-leipzig.de. 2. German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany. alexander.jobs@medizin.uni-leipzig.de. 3. Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig-Universitätsklinik, Strümpellstr. 39, 04289, Leipzig, Germany. alexander.jobs@medizin.uni-leipzig.de. 4. Medizinische Klinik I/Kardiologie, Angiologie und internistische Intensivmedizin, RWTH Aachen, Aachen, Germany. 5. Medizinische Klinik II/Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. 6. German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany. 7. Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig-Universitätsklinik, Strümpellstr. 39, 04289, Leipzig, Germany. 8. Institut für Physiologie, Universität zu Lübeck, Lübeck, Germany. 9. Institut für Medizinische Biometrie und Statistik, ZKS Lübeck, Universität zu Lübeck, Lübeck, Germany.
Abstract
AIM: Major clinical trials have shown that angiotensin-converting enzyme (ACE) inhibitors reduce mortality and morbidity in congestive heart failure (HF). Prior to these seminal findings hemodynamic effects of ACE inhibitors were examined in small studies. We aimed to review these studies systematically and meta-analyze the effects of ACE inhibitors on hemodynamics in HF. METHODS AND RESULTS: We identified studies investigating the acute hemodynamic effect of ACE inhibitors in naïve patients with congestive heart failure by searching PubMed and the Cochrane Central Register of Controlled Trials. We extracted the changes in hemodynamic measures and their standard errors from study reports or calculated these values from baseline and post-medication measurements. Data were pooled using random effects models. In total, 41 studies with 46 independent cohorts consisting of 676 patients were included. ACE inhibitor treatment reduced pulmonary capillary wedge pressure by 7.3 (95% confidence interval 6.4-8.2) mmHg and right atrial pressure by 3.7 (95% confidence interval 1.3-6.1) mmHg in patients with HF. Cardiac index increased by 0.4 (95% confidence interval 0.2-0.6) ml/min/m2. Changes in hemodynamic measures were strongly connected to each other in weighted simple linear regression models. CONCLUSION: Angiotensin-converting enzyme-inhibitors acutely reduced cardiac filling pressures and increased cardiac output in patients with congestive heart failure who were naïve for these drugs. These data indicate that ACE inhibitors exhibit a strong decongesting effect in congestive heart failure. In light of their impact on long-term prognosis, ACE inhibitors should also be considered as decongesting drugs in stable patients.
AIM: Major clinical trials have shown that angiotensin-converting enzyme (ACE) inhibitors reduce mortality and morbidity in congestive heart failure (HF). Prior to these seminal findings hemodynamic effects of ACE inhibitors were examined in small studies. We aimed to review these studies systematically and meta-analyze the effects of ACE inhibitors on hemodynamics in HF. METHODS AND RESULTS: We identified studies investigating the acute hemodynamic effect of ACE inhibitors in naïve patients with congestive heart failure by searching PubMed and the Cochrane Central Register of Controlled Trials. We extracted the changes in hemodynamic measures and their standard errors from study reports or calculated these values from baseline and post-medication measurements. Data were pooled using random effects models. In total, 41 studies with 46 independent cohorts consisting of 676 patients were included. ACE inhibitor treatment reduced pulmonary capillary wedge pressure by 7.3 (95% confidence interval 6.4-8.2) mmHg and right atrial pressure by 3.7 (95% confidence interval 1.3-6.1) mmHg in patients with HF. Cardiac index increased by 0.4 (95% confidence interval 0.2-0.6) ml/min/m2. Changes in hemodynamic measures were strongly connected to each other in weighted simple linear regression models. CONCLUSION:Angiotensin-converting enzyme-inhibitors acutely reduced cardiac filling pressures and increased cardiac output in patients with congestive heart failure who were naïve for these drugs. These data indicate that ACE inhibitors exhibit a strong decongesting effect in congestive heart failure. In light of their impact on long-term prognosis, ACE inhibitors should also be considered as decongesting drugs in stable patients.
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