Effect of aspirin and ifetroban on skeletal muscle blood flow in patients with congestive heart failure treated with enalapril
Stuart D. Katz, MD*,
Michael Radin, MD, FACC ,
Thomas Graves, PhD ,
Cynthia Hauck, MS,
Alan Block, PhD,
Thierry H. LeJemtel, MD for the Ifetroban Study Group
* Columbia Presbyterian Medical Center, Division of Circulatory Physiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
Pacific Coast Cardiology, Newport Beach, California, USA
Bristol Myers Squibb, Princeton, New Jersey, USA
Albert Einstein College of Medicine, Division of Cardiology, Department of Medicine, New York, New York, USA
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Figure 1 Schematic illustration of potential interactions of angiotensin-converting enzyme (ACE) inhibitors, bradykinin and aspirin on vascular prostacyclin (PGI2) production. Whether inhibition of vascular cyclooxygenase by antiplatelet doses of aspirin attenuates bradykin-induced prostaglandin-mediated vasodilation in response to ACE inhibition is uncertain. ATII = angiotensin II; + = stimulatory effect; – = inhibitory effect; ? = uncertain effect.
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Figure 2 Change from prerandomization baseline mean arterial pressure (MAP, mm Hg) after 4 h (black bars) and six weeks (gray bars) of combined administration of enalapril with placebo, aspirin and ifetroban. Values are expressed as means ± SEM.
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Figure 3 Changes in resting forearm blood flow (FBF, ml/min/100 ml, top panel) and resting forearm vascular resistance (FVR, mm Hg/ml/min/100 ml, bottom panel) from prerandomization baseline values after 4 h (black bars) and six weeks (gray bars) of combined administration of enalapril with placebo, aspirin and ifetroban. Values are expressed as means ± SEM.
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Figure 4 Changes in forearm blood flow during rhythmic handgrip exercise (FBF, ml/min/100 ml, top panel) and forearm vascular resistance during rhythmic handgrip exercise (FVR, mm Hg/ml/min/100 ml, bottom panel) from prerandomization baseline values after 4 h (black bars) and six weeks (gray bars) of combined administration of enalapril with placebo, aspirin and ifetroban. Values are expressed as means ± SEM.
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Figure 5 Changes in forearm blood flow after 5 min of arterial occlusion (FBF, ml/min/100 ml, top panel) and forearm vascular resistance after 5 min of arterial occlusion (FVR, mm Hg/ml/min/100 ml, bottom panel) from prerandomization baseline values after 4 h (black bars) and six weeks (gray bars) of combined administration of enalapril with placebo, aspirin and ifetroban. Values are expressed as means ± SEM.
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