Pretreatment with angiotensin-converting enzyme inhibitors attenuates ischemia-reperfusion injury.
BACKGROUND
The Heart Outcomes Prevention Evaluation (HOPE) trial demonstrated that ischemic events are decreased in patients receiving angiotensin-converting enzyme (ACE) inhibitors. This study sought to determine whether pretreatment with ACE inhibitors would attentuate ischemic injury during surgical revascularization of ischemic myocardium.


METHODS
In a porcine model, the second and third diagonal vessels were occluded for 90 minutes, followed by 45 minutes of cardioplegic arrest, and 180 minutes of reperfusion. Ten pigs received quinapril (20 mg p.o. q.d.) for 7 days prior to surgery; 10 others received no-ACE inhibitors.


RESULTS
Quinapril-treated animals required less cardioversions for ventricular arrhythmias (1.58 +/- 0.40 vs 2.77 +/- 0.22; p < 0.05), had higher wall motion scores assessed by two-dimensional echocardiography (4 = normal to -1 = dyskinesia; 2.11 +/- 0.10 vs 1.50 +/- 0.07; p < 0.05), more complete coronary artery endothelial relaxation to bradykinin (45% +/- 3% vs 7% +/- 4%; p < 0.005), and lower infarct size (24.0% +/- 3.0% vs 40.0% +/- 1.7%; p < 0.0001).


CONCLUSIONS
ACE inhibition prior to coronary revascularization enhances myocardial protection by decreasing ventricular irritability, improving regional wall motion, lowering infarct size, and preserving endothelial function.
Lazar
Harold L
HL
Department of Cardiothoracic Surgery, Boston Medical Center, Massachusetts 02118, USA. harold.lazar@bmc.org
Bao
Yusheng
Y
Rivers
Samuel
S
Bernard
Sheilah A
SA
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D000818:Animals; D003326:Coronary Circulation / Q000187:drug effects / Q000502:physiology; D004562:Electrocardiography / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D007546:Isoquinolines / Q000494:pharmacology*; D015428:Myocardial Reperfusion Injury / Q000503:physiopathology / Q000517:prevention & control*; D011292:Premedication; D000077583:Quinapril; D013552:Swine; D044005:Tetrahydroisoquinolines; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000517:prevention & control
D000806:Angiotensin-Converting Enzyme Inhibitors; D007546:Isoquinolines; D044005:Tetrahydroisoquinolines; D000077583:Quinapril