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(Circulation. 1995;92:2511-2518.)
© 1995 American Heart Association, Inc.

Articles

Radionuclide Monitoring of Cardiac Adaptations to Volume Loading in Patients With Dilated Cardiomyopathy and Mild Heart Failure

Effects of Angiotensin-Converting Enzyme Inhibition

Massimo Volpe, MD; Maria A.E. Rao, MD; Alberto Cuocolo, MD; Rosaria Russo, MD; Antonio Nappi, MD; Alessandro F. Mele, MD; Iolanda Enea, MD; Bruno Trimarco, MD; Mario Condorelli, MD

From the Prima Clinica Medica and Cattedra di Medicina Nucleare, Istituto di Scienze Radiologiche (A.C., A.N.), "Federico II" University, Naples, Italy.

Correspondence to Prof Massimo Volpe, MD, 1^a Clinica Medica, "Federico II" University, via Pansini, 5, 80131 Napoli, Italy. E-mail volpema@ds.cised.unina.it.

Background Cardiac adaptations to volume overload have been poorly investigated in heart failure. The aim of this study was to assess dynamic left ventricular responses to acute volume loading by continuous radionuclide monitoring in patients with asymptomatic to mildly symptomatic left ventricular dysfunction.

Methods and Results Left ventricular end-diastolic (EDV) and end-systolic (ESV) volumes, ejection fraction (EF), and peak filling rate (PFR) were monitored by a radionuclide detector (Vest) before and during volume expansion (sodium chloride, 0.9%, 0.25 mL · kg^-1 · min^-1 for 2 hours) in 10 patients with idiopathic dilated cardiomyopathy (DCM) and mild heart failure (New York Heart Association class I or II, ejection fraction <50%). The patients were studied off treatment and after 6 to 8 weeks of oral treatment with enalapril (5 mg/d). A control group of 11 age- and sex-matched healthy volunteers (N group) was also studied. In the N group, volume loading caused prompt and sustained increases of EDV, EF, and PFR (all P<.001), whereas ESV was progressively reduced (P<.001), and heart rate and blood pressure did not change. In contrast, in DCM, EDV showed a smaller increase than in the N group (two-way ANOVA: F=5.98, P<.001), ESV increased (P<.001), and EF and PFR remained unchanged. After enalapril, the cardiac adaptations to volume loading were restored to normal. In particular, EDV, EF, and PFR increased (P<.001), and ESV was reduced (P<.001). In 6 additional DCM patients studied before and after 6 to 8 weeks of placebo treatment, left ventricular responses to volume loading remained unchanged.

Conclusions Left ventricular dynamic adaptations to acute volume loading are compromised in patients with idiopathic DCM and mild heart failure. These impaired responses are ameliorated by treatment with enalapril.

Key Words: cardiomyopathy • radioisotopes • ventricles

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