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CLINICAL STUDIES

Improvement of myocardial blood flow to ischemic regions by angiotensin- converting enzyme inhibition with quinaprilat IV

A study using [¹⁵O] water dobutamine stress positron emission tomography

Christian A. Schneider, MD, Eberhard Voth, MD^*, Detlef Moka, MD^*, Frank M. Baer, MD^a, Jacques Melin, MD, FACC, Anne Bol, PhD, Rainer Wagner, PhD, Harald Schicha, MD^*, Erland Erdmann, MD, FACC^a and Udo Sechtem, MD, FACC^a

^a Klinik III für Innere Medizin, Universität zu Köln, Cologne, Germany
^* Klinik und Poliklinik für Nuklearmedizin, Universität zu Köln, Cologne, Germany
Positron Emission Tomography Laboratory, University of Louvain, Louvain-la-Neuve, Belgium
Max Planck Institut für Neurologische Forschung, Cologne, Germany

Manuscript received October 29, 1998; revised manuscript received May 4, 1999, accepted June 11, 1999.

Reprint requests and correspondence: Dr. Christian Schneider, Klinik III für Innere Medizin, Joseph-Stelzmann-Strasse 9, D-50924 Cologne, Germany.
christian.schneider{at}medizin.uni-koeln.de

OBJECTIVES

This study was designed to analyze the effects of acute angiotensin-converting enzyme (ACE) inhibition on myocardial blood flow (MBF) in control and ischemic regions.

BACKGROUND

Although animal studies indicate an improvement of MBF to ischemic regions after ACE inhibition, this effect has not been conclusively demonstrated in patients with coronary artery disease.

METHODS

Myocardial blood flow was analyzed in ischemic and nonischemic regions of 10 symptomatic patients with coronary artery disease using repetitive [¹⁵O] water positron emission tomography at rest and during maximal dobutamine stress before and after ACE inhibition with quinaprilat 10 mg IV. To exclude the possibility that repetitive ischemia may cause an increase in MBF, eight patients underwent the same protocol without quinaprilat (placebo patients).

RESULTS

Rate pressure product in control and quinaprilat patients was comparable. In placebo patients, repetitive dobutamine stress did not change MBF to ischemic regions (1.41 ± 0.17 during the first stress vs. 1.39 ± 0.19 ml/min/g during the second stress, p = 0.93). In contrast, MBF in ischemic regions increased significantly after acute ACE inhibition with quinaprilat during repetitive dobutamine stress (1.10 ± 0.13 vs. 1.69 ± 0.17 ml/min/g, p < 0.015). Dobutamine coronary reserve in ischemic regions remained unchanged in placebo patients (1.07 ± 0.11 vs. 1.10 ± 0.16, p = 0.92), but increased significantly after quinaprilat (0.97 ± 0.10 vs. 1.44 ± 0.14, p < 0.002). Total coronary resistance decreased after ACE inhibition (123 ± 19 vs. 71 ± 10 mm Hg·min·g/ml, p < 0.02).

CONCLUSIONS

Angiotensin-converting enzyme inhibition by quinaprilat significantly improves MBF to ischemic regions in patients with coronary artery disease.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   ECG = electrocardiogram   FDG = [18F]fluoro-deoxyglucose   MBF = myocardial blood flow   NO = nitric oxide   PET = positron emission tomography   RPP = rate pressure product   TCR = total coronary resistance

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