One hundred and sixteen senile patients (older than 65 years) with chronic heart failure (CHF) were analyzed retrospectively in order to verify if old patients with CHF would benefit from long-term (one year) angiotension-converting enzyme inhibitor (ACEI) treatment. The frequency of drugs (including ACEI, digitalis and diuretic) used was stratified into four degrees accordingly. Development of the CHF was scored with regard to relapse rate and severity of this disease. Stepwise regression analysis was applied to explore the relationship between the scored outcome of CHF and the frequency of individual drug administration. A significant relationship of the scored outcome of CHF to the frequency of ACEI usage but not to digitalis nor to diuretics was found (partial coefficient of the correlation r = 0.42, P = 0.002). It was concluded that the long-term administration of ACEI improves the outcome of CHF in senile patients.
Angiotensin-Converting Enzyme Inhibitors/*administration & dosage ; Chronic Disease ; Heart Failure, Congestive/*drug therapy ; Heart Failure, Congestive/etiology ; Hypertension/complications ; Myocardial Ischemia/complications ; Retrospective Studies ; Treatment Outcome

Brain natriuretic peptide (BNP), a neurohormone secreted from the ventricular myocardium in response to hemodynamic load/wall stress, in congestive heart failure (CHF). This study was performed to evaluate the correlation between BNP level and clinical presentations and hemodynamic parameters obtained by echo-Doppler (echo-Doppler) analysis, and its relation with disease severity and ventricular load/wall stress. CHF patients (n=246) were subgrouped by clinical presentations and echo-Doppler findings into 4 groups: diastolic HF only, chronic HF, acute HF, and chronic HF with acute exacerbation. A BNP level of 81.2 pg/ml showed a sensitivity/ specificity of 53.3%/98.4% for detecting CHF (AUC, 0.882; p< 0.0001), and was found to be closely related with the NYHA classification (p< 0.0001). Log BNP was related with LVEF (r2=0.3015, p< 0.0001) and the Meridional wall stress index (r2=0.4052, p< 0.0001). The difference between the BNP levels of the subgroups and BNP control was significant (p< 0.0001), exept between the HF group and the controls; control (n=114, 20.9 +/- 31.4pg/ml), only diastolic HF (n=84, 89.8 +/- 117.6pg/ml), chronic HF (n=60, 208.2 +/- 210.2pg/ml), acute HF (n=28, 477.9 +/- 498.4 pg/ml), chronic HF with acute exacerbation (n= 74, 754.1 +/- 419.2pg/ml). The BNP level was significantly higher in the only diastolic HF group than in the asymptomatic control group with diastolic dysfunction (89.8 +/- 12.8 vs. 22.8 +/- 5.1pg/ml, p< 0.0001). BNP may be a good indicator for the differential diagnosis of a broad spectrum of heart failures. And, elevated BNP might help to diagnose diastolic HF in patients with diastolic dysfunction.
Adult ; Aged ; Atrial Natriuretic Factor/*blood ; Echocardiography ; Female ; Heart Failure, Congestive/*blood/*complications/ultrasonography ; Human ; Male ; Middle Aged ; Natriuretic Peptide, Brain ; Prognosis ; Support, Non-U.S. Gov't ; Ventricular Dysfunction/*etiology