PMID- 1746416
OWN - NLM
STAT- MEDLINE
DCOM- 19920116
LR  - 20190622
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 68
IP  - 14
DP  - 1991 Nov 18
TI  - Influence of severity of heart failure on the efficacy of angiotensin-converting 
      enzyme inhibition.
PG  - 121D-126D
AB  - Angiotensin-converting enzyme (ACE) inhibition slowed the progression of 
      congestive heart failure (CHF) in 170 patients who were randomly assigned to 
      either captopril or placebo in the Munich Mild Heart Failure Trial. The two major 
      end points were progression from New York Heart Association (NYHA) functional 
      classes I, II, or III to class IV, despite optimal, adjusted standard therapy, 
      and death due to CHF. The relative risk for progressive CHF with captopril 
      therapy was 0.34 (95% confidence interval = 0.17-0.68; p = 0.01). A total of 52 
      prerandomization variables were tested to determine their contribution to disease 
      progression. Logistic regression analysis revealed 5 independent risk factors for 
      progressive CHF: NYHA class, left ventricular end-systolic diameter, need for 
      diuretic, age, and cardiothoracic ratio. The presence of greater than 2 of these 
      risk factors increased the odds ratio for progression to 8.13 (p less than 0.001) 
      compared with the presence of 0-2 risk factors. However, the effectiveness of 
      captopril in preventing progression was higher within the subgroup of patients 
      who had less severe CHF: the odds ratio was 0.12 (95% confidence interval = 
      0.03-0.45; p less than 0.01) for patients in NYHA class I or II on captopril and 
      was 0.83 for those in class III. We conclude that the severity of CHF, as 
      represented by the above-defined risk factors, is directly related to the 
      likelihood for the development of progressive heart failure. However, the less 
      severe the heart failure, the more effective the treatment with captopril will be 
      in preventing disease progression. Thus, ACE inhibition has considerable 
      potential for improving the prognosis of patients with mild heart failure.
FAU - Kleber, F X
AU  - Kleber FX
AD  - Division of Cardiology, Munich-Schwabing Hospital, Ludwig-Maximilians-University, 
      Germany.
FAU - Niemoller, L
AU  - Niemoller L
FAU - Fischer, M
AU  - Fischer M
FAU - Doering, W
AU  - Doering W
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Digitalis Glycosides)
RN  - 0 (Diuretics)
RN  - 0 (Nitrates)
RN  - 0 (Placebos)
RN  - 9G64RSX1XD (Captopril)
SB  - IM
MH  - Age Factors
MH  - Captopril/*therapeutic use
MH  - Cardiac Output, Low/etiology/*prevention & control
MH  - Cause of Death
MH  - Coronary Disease/complications
MH  - Digitalis Glycosides/therapeutic use
MH  - Diuretics/therapeutic use
MH  - Double-Blind Method
MH  - Female
MH  - Heart Arrest/mortality
MH  - Heart Failure/etiology/mortality/physiopathology/*prevention & control
MH  - Heart Ventricles/pathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/complications
MH  - Nitrates/therapeutic use
MH  - Placebos
MH  - Regression Analysis
MH  - Risk Factors
MH  - Systole
MH  - Thorax/pathology
EDAT- 1991/11/18 00:00
MHDA- 1991/11/18 00:01
CRDT- 1991/11/18 00:00
PHST- 1991/11/18 00:00 [pubmed]
PHST- 1991/11/18 00:01 [medline]
PHST- 1991/11/18 00:00 [entrez]
AID - 0002-9149(91)90269-Q [pii]
AID - 10.1016/0002-9149(91)90269-q [doi]
PST - ppublish
SO  - Am J Cardiol. 1991 Nov 18;68(14):121D-126D. doi: 10.1016/0002-9149(91)90269-q.