This Article Abstract 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 Wittstein, I. S. Articles by Hare, J. M. Search for Related Content PubMed PubMed Citation Articles by Wittstein, I. S. Articles by Hare, J. M.

Cardiac nitric oxide production due to angiotensin-converting enzyme inhibition decreases beta-adrenergic myocardial contractility in patients with dilated cardiomyopathy

^a Division of Cardiology, The Johns Hopkins Hospital, Baltimore, Maryland, USA

View larger version (20K): [in a new window]   Figure 1 Representative steady state pressure-volume data. Depicted are the effects of intracoronary enalaprilat and NG-monomethyl-L-arginine (L-NMMA) on beta-adrenergic contractility, as assessed by single-beat ventricular elastance (Ees). Group I (with dilated cardiomyopathy [DCM]) and Group III (normal subjects) received enalaprilat before L-NMMA. Group II (with DCM) received L-NMMA before enalaprilat. In each group, baseline Ees values are shown as a dashed line. Pressure-volume loops and Ees values are shown at baseline (circles) and in the presence of dobutamine (Dob, squares), enalaprilat (Enal, triangles) and L-NMMA (diamonds). The numbers in parentheses represent the order of drug infusion.

View larger version (19K): [in a new window]   Figure 2 Effect of intracoronary enalaprilat (ENAL) and NG-monomethyl-L-arginine (L-NMMA) on the positive inotropic response to dobutamine (DOB) in patients with dilated cardiomyopathy (DCM) (Groups I and II) and in patients with normal left ventricular function (Group III). Dobutamine was infused intravenously in all groups to achieve +dP/dt >30% above baseline. In Groups I and III, enalaprilat was infused intracoronarily for 15 min before co-infusion with L-NMMA. In Group II, L-NMMA was administered before enalaprilat. Depicted are the percent changes in +dP/dt (open bars) and Ees (single-beat elastance; solid bars) with each drug infusion relative to baseline. *p < 0.05 versus dobutamine and versus L-NMMA. Ees values are only available for two of the five patients in Group II.

View larger version (19K): [in a new window]   Figure 3 Effect of enalaprilat (Enal, triangles) and NG-monomethyl-L-arginine (L-NMMA) (diamonds) on the end-diastolic pressure-volume relationship (EDPVR) in the presence of dobutamine (Dob, squares) in patients with DCM (Groups I and II) and subjects with normal left ventricular function (Group III). Depicted are representative steady state end-diastolic pressure-volume data. The numbers in parentheses represent the order of drug infusion for each group. In Group I, enalaprilat resulted in a downward shift of the EDPVR, an effect reversed by subsequent L-NMMA co-infusion. In Group II, L-NMMA prevented the EDPVR reduction to enalaprilat. Enalaprilat had no effect on EDPVR in Group III.