Enalapril decreases prevalence of ventricular tachycardia in patients with chronic congestive heart failure

R. D. Fletcher, G. B. Cintron, G. Johnson, J. Orndorff, P. Carson, J. N. Cohn

Research output: Contribution to journalArticle

98 Citations (Scopus)

Abstract

Background. Patients with heart failure have a high prevalence of serious arrhythmias and sudden cardiac death. Methods and Results. Male patients aged 18-75 years with chronic heart failure were randomized to enalapril or hydralazine-isosorbide dinitrate. Short-term (4-hour to 8-hour) Holter tape recordings were performed before randomization, at 3 months, at 1 year, and yearly thereafter. Of 804 patients randomized to therapy, 715 had Holters at baseline. Couplets were noted in 56% versus 60% and ventricular tachycardia (VT) (three or more consecutive ventricular premature beats) in 27% versus 29% of patients randomized to enalapril versus hydralazine-isosorbide dinitrate, respectively. The presence of VT at 3 months, 1 year, and 2 years predicted significantly higher mortality during the subsequent year (p<0.0001, p<0.001, and p<0.037, respectively). In the enalapril group, VT prevalence decreased by 27% at 1 year (p<0.02). A decrease in prevalence of VT was not seen in the hydralazine-isosorbide dinitrate group. New VT was seen in 11% of enalapril patients versus 24% of hydralazine-isosorbide dinitrate patients at 1 year (p<0.002). When compared with hydralazine- isosorbide dinitrate at 1 and 2 years, there was a 52% and 49% reduction, respectively, in sudden deaths in the enalapril group. Thus, at 1 and 2 years, the decrease in sudden deaths in the enalapril group coincided with the decrease in VT prevalence and the decrease in new VT emergence. Conclusions. In patients with heart failure, VT and couplets predict increased mortality. When compared with hydralazine-isosorbide dinitrate, enalapril decreases both the persistence of baseline VT at 3 months and the emergence of new VT at 1 and 2 years. The reduction in VT prevalence parallels a reduction in sudden death. The effect of enalapril on survival over hydralazine-isosorbide dinitrate may be related to its ability to reduce prevalence of ventricular arrhythmia.

Original languageEnglish (US)
JournalCirculation
Volume87
Issue number6 SUPPL. VI
StatePublished - Jun 1993

Fingerprint

Enalapril
Ventricular Tachycardia
Isosorbide Dinitrate
Hydralazine
Heart Failure
Sudden Death
Cardiac Arrhythmias
Tape Recording
Ventricular Premature Complexes
Mortality
Sudden Cardiac Death
Random Allocation

Keywords

  • congestive heart failure
  • enalapril
  • mortality
  • ventricular tachycardia

Cite this

Fletcher, R. D., Cintron, G. B., Johnson, G., Orndorff, J., Carson, P., & Cohn, J. N. (1993). Enalapril decreases prevalence of ventricular tachycardia in patients with chronic congestive heart failure. Circulation, 87(6 SUPPL. VI).

Enalapril decreases prevalence of ventricular tachycardia in patients with chronic congestive heart failure. / Fletcher, R. D.; Cintron, G. B.; Johnson, G.; Orndorff, J.; Carson, P.; Cohn, J. N.

In: Circulation, Vol. 87, No. 6 SUPPL. VI, 06.1993.

Research output: Contribution to journalArticle

Fletcher, RD, Cintron, GB, Johnson, G, Orndorff, J, Carson, P & Cohn, JN 1993, 'Enalapril decreases prevalence of ventricular tachycardia in patients with chronic congestive heart failure', Circulation, vol. 87, no. 6 SUPPL. VI.
Fletcher RD, Cintron GB, Johnson G, Orndorff J, Carson P, Cohn JN. Enalapril decreases prevalence of ventricular tachycardia in patients with chronic congestive heart failure. Circulation. 1993 Jun;87(6 SUPPL. VI).
Fletcher, R. D. ; Cintron, G. B. ; Johnson, G. ; Orndorff, J. ; Carson, P. ; Cohn, J. N. / Enalapril decreases prevalence of ventricular tachycardia in patients with chronic congestive heart failure. In: Circulation. 1993 ; Vol. 87, No. 6 SUPPL. VI.
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T1 - Enalapril decreases prevalence of ventricular tachycardia in patients with chronic congestive heart failure

AU - Fletcher, R. D.

AU - Cintron, G. B.

AU - Johnson, G.

AU - Orndorff, J.

AU - Carson, P.

AU - Cohn, J. N.

PY - 1993/6

Y1 - 1993/6

N2 - Background. Patients with heart failure have a high prevalence of serious arrhythmias and sudden cardiac death. Methods and Results. Male patients aged 18-75 years with chronic heart failure were randomized to enalapril or hydralazine-isosorbide dinitrate. Short-term (4-hour to 8-hour) Holter tape recordings were performed before randomization, at 3 months, at 1 year, and yearly thereafter. Of 804 patients randomized to therapy, 715 had Holters at baseline. Couplets were noted in 56% versus 60% and ventricular tachycardia (VT) (three or more consecutive ventricular premature beats) in 27% versus 29% of patients randomized to enalapril versus hydralazine-isosorbide dinitrate, respectively. The presence of VT at 3 months, 1 year, and 2 years predicted significantly higher mortality during the subsequent year (p<0.0001, p<0.001, and p<0.037, respectively). In the enalapril group, VT prevalence decreased by 27% at 1 year (p<0.02). A decrease in prevalence of VT was not seen in the hydralazine-isosorbide dinitrate group. New VT was seen in 11% of enalapril patients versus 24% of hydralazine-isosorbide dinitrate patients at 1 year (p<0.002). When compared with hydralazine- isosorbide dinitrate at 1 and 2 years, there was a 52% and 49% reduction, respectively, in sudden deaths in the enalapril group. Thus, at 1 and 2 years, the decrease in sudden deaths in the enalapril group coincided with the decrease in VT prevalence and the decrease in new VT emergence. Conclusions. In patients with heart failure, VT and couplets predict increased mortality. When compared with hydralazine-isosorbide dinitrate, enalapril decreases both the persistence of baseline VT at 3 months and the emergence of new VT at 1 and 2 years. The reduction in VT prevalence parallels a reduction in sudden death. The effect of enalapril on survival over hydralazine-isosorbide dinitrate may be related to its ability to reduce prevalence of ventricular arrhythmia.

AB - Background. Patients with heart failure have a high prevalence of serious arrhythmias and sudden cardiac death. Methods and Results. Male patients aged 18-75 years with chronic heart failure were randomized to enalapril or hydralazine-isosorbide dinitrate. Short-term (4-hour to 8-hour) Holter tape recordings were performed before randomization, at 3 months, at 1 year, and yearly thereafter. Of 804 patients randomized to therapy, 715 had Holters at baseline. Couplets were noted in 56% versus 60% and ventricular tachycardia (VT) (three or more consecutive ventricular premature beats) in 27% versus 29% of patients randomized to enalapril versus hydralazine-isosorbide dinitrate, respectively. The presence of VT at 3 months, 1 year, and 2 years predicted significantly higher mortality during the subsequent year (p<0.0001, p<0.001, and p<0.037, respectively). In the enalapril group, VT prevalence decreased by 27% at 1 year (p<0.02). A decrease in prevalence of VT was not seen in the hydralazine-isosorbide dinitrate group. New VT was seen in 11% of enalapril patients versus 24% of hydralazine-isosorbide dinitrate patients at 1 year (p<0.002). When compared with hydralazine- isosorbide dinitrate at 1 and 2 years, there was a 52% and 49% reduction, respectively, in sudden deaths in the enalapril group. Thus, at 1 and 2 years, the decrease in sudden deaths in the enalapril group coincided with the decrease in VT prevalence and the decrease in new VT emergence. Conclusions. In patients with heart failure, VT and couplets predict increased mortality. When compared with hydralazine-isosorbide dinitrate, enalapril decreases both the persistence of baseline VT at 3 months and the emergence of new VT at 1 and 2 years. The reduction in VT prevalence parallels a reduction in sudden death. The effect of enalapril on survival over hydralazine-isosorbide dinitrate may be related to its ability to reduce prevalence of ventricular arrhythmia.

KW - congestive heart failure

KW - enalapril

KW - mortality

KW - ventricular tachycardia

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