From the Department of Cardiology, Laiko Hospital of Athens (M.K., F.T.,
P.M., G.A.K.); Department of Cardiology, Hippokration Hospital (J.D., A.E.A.),
University of Athens; and State Cardiac Department, Hippokration Hospital
(J.E.G.), Athens, Greece.
Correspondence to Michael Kyriakidis, MD, Department of Cardiology, Laiko Hospital of Athens, 17 Agiou Thoma St, Goudi 115 27, Athens, Greece.
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 (
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.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Effects of Cardiac Versus Circulatory Angiotensin-Converting Enzyme Inhibition on Left Ventricular Diastolic Function and Coronary Blood Flow in Hypertrophic Obstructive Cardiomyopathy
G) (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,
G 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).
Key Words: angiotensin • enzymes • hypertrophy • cardiomyopathy
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