This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by van den Heuvel, A. F. M. Articles by van Veldhuisen, D. J. Search for Related Content PubMed PubMed Citation Articles by van den Heuvel, A. F. M. Articles by van Veldhuisen, D. J.

CLINICAL STUDY: MYOCARDIAL ISCHEMIA

Reduction of exercise-induced myocardial ischemia during add-on treatment with the angiotensin-converting enzyme inhibitor enalapril in patients with normal left ventricular function and optimal beta blockade

^a Department of Cardiology/Thoraxcenter, University Hospital Groningen, Netherlands
^b Ignatius Hospital, Breda, Netherlands
^c Medisch Spectrum Twente, Enschede, Netherlands
^d Department of Internal Medicine I/COEUR, University Hospital Dijkzigt, Rotterdam, Netherlands

Manuscript received March 17, 2000; revised manuscript received August 12, 2000, accepted October 2, 2000.

Reprint requests and correspondence: Prof. Dr. Dirk J. van Veldhuisen, Dept. of Cardiology/Thoraxcenter, University Hospital Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
d.j.van_veldhuisen{at}thorax.azg.nl

OBJECTIVES

We sought to study the effect of angiotensin-converting enzyme inhibition on exercise-induced myocardial ischemia.

BACKGROUND

Although angiotensin-converting enzyme inhibitors have been shown to reduce ischemic events after myocardial infarction, few data are available regarding their direct anti-ischemic effects in patients with coronary artery disease.

METHODS

We studied 43 patients (average age 63 ± 8 years) with exercise-induced myocardial ischemia (0.1 mV ST depression, despite optimal beta blockade) and normal left ventricular function (ejection fraction >0.50). In a double-blind, placebo-controlled parallel design, patients were treated with angiotensin-converting enzyme inhibitor (enalapril 10 mg twice daily) or placebo. Assessments were made after three weeks (short-term) and 12 weeks (long-term).

RESULTS

At baseline, the groups were well matched for all clinical characteristics. After three weeks, there was a slight but not significant increase in time to 0.1 mV ST depression in both groups (p = NS); rate pressure product (RPP = heart rate x systolic blood pressure) was also unaffected. After 12 weeks, however, time to 0.1 mV ST depression further increased in the enalapril group (5.6 ± 1.9 min) but was unchanged in the placebo group (4.4 ± 1.3 min; p < 0.05 between groups). In contrast, RPP was not affected. Concentrations of both atrial and brain natriuretic peptides at peak exercise tended to be lower by enalapril, if compared to placebo (p = NS).

CONCLUSIONS

Angiotensin-converting enzyme inhibition may reduce exercise-induced myocardial ischemia in patients with normal left ventricular function. Further studies are needed to elucidate the mechanisms involved.

Abbreviations and Acronyms   ANP = atrial natriuretic peptide   BNP = brain natriuretic peptide   CAD = coronary artery disease   LV = left ventricular   RPP = rate pressure product

This article has been cited by other articles:

				N. Danchin, M. Cucherat, C. Thuillez, E. Durand, Z. Kadri, and P. G. Steg Angiotensin-Converting Enzyme Inhibitors in Patients With Coronary Artery Disease and Absence of Heart Failure or Left Ventricular Systolic Dysfunction: An Overview of Long-term Randomized Controlled Trials. Arch Intern Med, April 10, 2006; 166(7): 787 - 796. [Abstract] [Full Text] [PDF]

				C. J. Pepine, J.-L. Rouleau, K. Annis, A. Ducharme, P. Ma, J. Lenis, R. Davies, U. Thadani, B. Chaitman, H. E. Haber, et al. Effects of angiotensin-converting enzyme inhibition on transient ischemia: The quinapril anti-ischemia and symptoms of angina reduction (QUASAR) trial J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2049 - 2059. [Abstract] [Full Text] [PDF]