| Effects of cardiac versus circulatory angiotensin-converting enzyme inhibition on left ventricular diastolic function and coronary blood flow in hypertrophic obstructive cardiomyopathy. | |
MedLine Citation:
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PMID: 9577944 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
Authors:
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M Kyriakidis; F Triposkiadis; J Dernellis; A E Androulakis; P Mellas; G A Kelepeshis; J E Gialafos |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article |
Journal Detail:
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Title: Circulation Volume: 97 ISSN: 0009-7322 ISO Abbreviation: Circulation Publication Date: 1998 Apr |
Date Detail:
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Created Date: 1998-05-27 Completed Date: 1998-05-27 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1342-7 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiology, Laiko Hospital of Athens, Greece. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult 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 Echocardiography Enalaprilat / therapeutic use* Female Heart / drug effects Hemodynamics / drug effects Humans Infusions, Parenteral Male Middle Aged Prospective Studies Ventricular Dysfunction, Left / drug therapy* |
| Chemical | |
Reg. No./Substance:
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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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