Document Detail

Effects of cardiac versus circulatory angiotensin-converting enzyme inhibition on left ventricular diastolic function and coronary blood flow in hypertrophic obstructive cardiomyopathy.
MedLine Citation:
PMID:  9577944     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Left ventricular (LV) diastolic function and coronary flow are impaired in hypertrophic obstructive cardiomyopathy (HOCM). This study was designed to evaluate the impact of cardiac and circulatory ACE inhibition on such derangements. METHODS AND RESULTS: Twenty patients with HOCM underwent cardiac ACE inhibition with intracoronary (IC) enalaprilat (0.05 mg/min infused into the left anterior descending coronary artery for 15 minutes) followed by circulatory ACE inhibition with 25 mg sublingual (SL) captopril. Contrast ventriculography, pressure, and coronary flow measurements were performed at baseline, after IC enalaprilat infusion, and 45 minutes after SL captopril. Heart rate was not affected by the respective interventions (75+/-11 versus 76+/-13 versus 75+/-10 bpm; P=NS), whereas mean aortic pressure dropped slightly after IC enalaprilat and significantly after SL captopril (90+/-8 versus 85+/-10 versus 74+/-9 mm Hg; P<.05). Compared with baseline, IC enalaprilat resulted in a decrease in LV end-diastolic pressure (17.6+/-5.9 versus 14.4+/-4.9 mm Hg; P<.05), time constant of isovolumic LV pressure relaxation (tauG) (69+/-9 versus 52+/-10 ms; P<.05), and outflow gradient (45.2+/-6.9 versus 24.4+/-3.7 mm Hg; P<.05) and in an increase in coronary blood flow (107+/-10 versus 127+/-12 mL/min; P<.05) and coronary flow reserve (2.2+/-0.4 versus 2.6+/-0.3; P<.05). After SL captopril, tauG was prolonged (60+/-13 ms; P<.05 versus IC enalaprilat), and LV outflow gradient, coronary blood flow, and coronary flow reserve values returned to baseline (45.5+/-5.3 mm Hg, 107+/-12 mL/min, and 2.2+/-0.5, respectively; P=NS versus baseline). CONCLUSIONS: Activation of the cardiac renin-angiotensin system contributes to LV diastolic dysfunction as well as to the decreased coronary blood flow and coronary flow reserve in HOCM. Cardiac ACE inhibition restores and circulatory ACE inhibition aggravates the above derangements.
M Kyriakidis; F Triposkiadis; J Dernellis; A E Androulakis; P Mellas; G A Kelepeshis; J E Gialafos
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Circulation     Volume:  97     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1998 Apr 
Date Detail:
Created Date:  1998-05-27     Completed Date:  1998-05-27     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1342-7     Citation Subset:  AIM; IM    
Department of Cardiology, Laiko Hospital of Athens, Greece.
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MeSH Terms
Analysis of Variance
Angiotensin-Converting Enzyme Inhibitors / blood,  therapeutic use*
Captopril / therapeutic use*
Cardiomyopathy, Hypertrophic / drug therapy*,  physiopathology
Coronary Circulation / drug effects*
Diastole / drug effects
Enalaprilat / therapeutic use*
Heart / drug effects
Hemodynamics / drug effects
Infusions, Parenteral
Middle Aged
Prospective Studies
Ventricular Dysfunction, Left / drug therapy*
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 62571-86-2/Captopril; 84680-54-6/Enalaprilat

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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