Myocardial and coronary effects of captopril during pacing-induced ischaemia in patients with coronary artery disease.
It has been speculated that ACE inhibitors may have beneficial effects in patients with coronary artery disease not only by their vasodilator properties but also by an effect on an assumed local renin-angiotensin system in atherosclerotic coronary arteries. Thus, the aim of the present study was to evaluate the effect of a single intravenous infusion of captopril on haemodynamics and coronary diameter at rest and during myocardial ischaemia induced by rapid atrial pacing. The study was performed in 12 patients with coronary artery disease and exertional angina pectoris despite medical therapy. Central haemodynamics (PAO, PAP) and left ventricular end-diastolic pressure were measured. Biplane cineventriculography and coronary arteriography were performed during control pacing (10% above the normal heart rate) before and after 15 min of captopril infusion, as well as during angina pectoris induced by rapid atrial pacing before and after captopril (six patients 0.15 mg kg-1, six patients 0.3 mg kg-1). Mean aortic pressure was not significantly decreased by either 0.15 mg kg-1 or 0.3 mg kg-1, whereas mean pulmonary pressure was significantly reduced by captopril by 28% at rest and 34% during rapid atrial pacing. Neither the endsystolic volume index nor left ventricular ejection fraction was significantly affected by captopril. Left ventricular end-diastolic volume index was reduced by 9% at rest and 7% during pacing-induced angina. Left ventricular end-diastolic pressure decreased from 11 +/- 9 mmHg to 4.8 +/- 4.1 mmHg at rest after captopril, and from 10 +/- 11 mmHg to 5.1 +/- 5.0 mmHg during pacing-induced angina after captopril.(ABSTRACT TRUNCATED AT 250 WORDS)
Karsch
K R
KR
Medical Clinic, University of Tuebingen, F.R.G.
Voelker
W
W
Mauser
M
M
D000787:Angina Pectoris / Q000188:drug therapy; D001794:Blood Pressure / Q000187:drug effects; D002216:Captopril / Q000494:pharmacology*; D002306:Cardiac Volume / Q000187:drug effects; D003327:Coronary Disease / Q000188:drug therapy*; D015444:Exercise; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D014654:Vascular Patency / Q000187:drug effects*; D014664:Vasodilation / Q000187:drug effects
D002216:Captopril