Effects of losartan and captopril on left ventricular volumes in elderly patients with heart failure

Results of the elite ventricular function substudy

Marvin A. Konstam, Richard D. Patten, Ignatious Thomas, Tarik Ramahi, Kenneth La Bresh, Steven Goldman, William Lewis, Alan Gradman, K. Stanley Self, Vera Bittner, William Rand, Debra Kinan, John J. Smith, Tim Ford, Robert Segal, James E. Udelson

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Background: The mechanism by which angiotensin-converting enzyme inhibitors reduce mortality rates and disease progression in patients with heart failure is likely mediated in part through prevention of adverse ventricular remodeling. This study examined the effects of the angiotensin- converting enzyme inhibitor captopril and the angiotensin II type 1 receptor antagonist losartan on ventricular volumes and function in elderly patients with heart failure and reduced left ventricular ejection fraction (≤40%). Methods: Patients underwent radionuclide ventriculograms (RVG) at baseline and were randomized to either captopril (n = 16) or losartan (n = 13). After 48 weeks, another RVG was obtained. Therapy was then withdrawn for at least 5 days, and the RVG was repeated while the patient was not receiving the drug. Results: At 48 weeks both captopril and losartan significantly reduced left ventricular (LV) end-diastolic volume index (13.5 ± 26 to 128 ± 23 mL/m2 for losartan, P < .05 vs baseline; 142 ± 25 to 131 ± 20 mL/m2 for captopril, P < .01. mean (SD). Captopril also reduced LV end-systolic volume index (98 ± 24 to 89 ± 21 mL/m2, P < .01 vs. baseline), whereas a nonsignificant trend was observed for the losartan group (97 ± 23 to 90 ± 16 mL/m2, P = not significant). The between-group differences in the changes in LV volumes were not statistically significant. After drug withdrawal, LV end-diastolic volume index remained significantly lower than baseline in the captopril group (P < .01). Conclusions: Both captopril and losartan prevent LV dilation, representing adverse ventricular remodeling, previously seen with placebo treatment. Reverse remodeling was observed in the captopril group. On the basis of these results, the relative effects on LV remodeling do not provide a rationale for a survival benefit of losartan over captopril.

Original languageEnglish (US)
Pages (from-to)1081-1087
Number of pages7
JournalAmerican Heart Journal
Volume139
Issue number6
DOIs
StatePublished - Jun 2000
Externally publishedYes

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Losartan
Ventricular Function
Captopril
Heart Failure
Stroke Volume
Ventricular Remodeling
Radioisotopes
Angiotensin-Converting Enzyme Inhibitors
Angiotensin II Type 1 Receptor Blockers
Pharmaceutical Preparations
Disease Progression
Dilatation
Placebos
Survival
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effects of losartan and captopril on left ventricular volumes in elderly patients with heart failure : Results of the elite ventricular function substudy. / Konstam, Marvin A.; Patten, Richard D.; Thomas, Ignatious; Ramahi, Tarik; La Bresh, Kenneth; Goldman, Steven; Lewis, William; Gradman, Alan; Stanley Self, K.; Bittner, Vera; Rand, William; Kinan, Debra; Smith, John J.; Ford, Tim; Segal, Robert; Udelson, James E.

In: American Heart Journal, Vol. 139, No. 6, 06.2000, p. 1081-1087.

Research output: Contribution to journalArticle

Konstam, MA, Patten, RD, Thomas, I, Ramahi, T, La Bresh, K, Goldman, S, Lewis, W, Gradman, A, Stanley Self, K, Bittner, V, Rand, W, Kinan, D, Smith, JJ, Ford, T, Segal, R & Udelson, JE 2000, 'Effects of losartan and captopril on left ventricular volumes in elderly patients with heart failure: Results of the elite ventricular function substudy', American Heart Journal, vol. 139, no. 6, pp. 1081-1087. https://doi.org/10.1067/mhj.2000.105302
Konstam, Marvin A. ; Patten, Richard D. ; Thomas, Ignatious ; Ramahi, Tarik ; La Bresh, Kenneth ; Goldman, Steven ; Lewis, William ; Gradman, Alan ; Stanley Self, K. ; Bittner, Vera ; Rand, William ; Kinan, Debra ; Smith, John J. ; Ford, Tim ; Segal, Robert ; Udelson, James E. / Effects of losartan and captopril on left ventricular volumes in elderly patients with heart failure : Results of the elite ventricular function substudy. In: American Heart Journal. 2000 ; Vol. 139, No. 6. pp. 1081-1087.
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T2 - Results of the elite ventricular function substudy

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AU - Patten, Richard D.

AU - Thomas, Ignatious

AU - Ramahi, Tarik

AU - La Bresh, Kenneth

AU - Goldman, Steven

AU - Lewis, William

AU - Gradman, Alan

AU - Stanley Self, K.

AU - Bittner, Vera

AU - Rand, William

AU - Kinan, Debra

AU - Smith, John J.

AU - Ford, Tim

AU - Segal, Robert

AU - Udelson, James E.

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