Impairment of myocardial blood flow reserve in patients with asymptomatic left ventricular dysfunction: Effects of ACE-inhibition with perindopril

AFM van den Heuvel*, PK Blanksma, HMJ Siebelink, LM van Wijk, F Boomsma, W Vaalburg, HJGM Crijns, DJ van Veldhuisen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Myocardial blood flow (MBF) reserve is impaired in patients with symptomatic chronic heart failure. Whether this is already present in asymptomatic left ventricular (LV) dysfunction, and whether it is affected by angiotensin converting enzyme (ACE) inhibition, is unknown. We examined MBF in 20 patients with asymptomatic LV dysfunction and compared them to healthy volunteers. MBF (reserve) was assessed with positron emission tomography (PET) and N-13 ammonia at rest, during dipyridamole stress test (DST) and during cold pressor test (CPT). Further, in the LV-dysfunction group, we studied the effects of 3 months treatment with ACE inhibition with a second PET study. Patients were randomized double-blind to perindopril 4 mg daily or placebo. MBF at rest was similar in controls and patients. DST-induced MBF reserve, however, was decreased in patients vs. controls (1.71 +/- 0.2 vs. 2.62 +/- 0.5, respectively p <0.05). Also CPT-induced MBF was lower in patients (1.14 +/- 0.06 vs. 1.23 +/- 0.03, p <0.05). After 3 months double-blind treatment, CPT-induced MBF decreased in the placebo group (from 1.12 +/- 0.02 to 0.93 +/- 0.06), but was preserved in the perindopril group (from 1.16 +/- 0.08 to 1.14 +/- 0.08 shifts from baseline: -0.19 +/- 0.05 vs. -0.02 +/- 0.07 respectively p = 0.07). This was compatible with a trend to a smaller increase in coronary vascular resistance during CPT (1.23 +/- 0.08 vs. 1.03 +/- 0.06, placebo vs. perindopril, p = 0.06). In patients with asymptomatic LV dysfunction, MBF, both after vasodilation and after CPT, is already impaired. ACE inhibition with perindopril during this short-term treatment had no significant effects.

Original languageEnglish
Pages (from-to)353-359
Number of pages7
JournalInternational Journal Of Cardiovascular Imaging
Volume17
Issue number5
Publication statusPublished - Sep-2001

Keywords

  • ACE inhibitors
  • coronary circulation
  • endothelial function
  • flow reserve
  • heart failure
  • myocardial blood flow
  • CORONARY-ARTERY DISEASE
  • CONVERTING ENZYME-INHIBITION
  • CONGESTIVE-HEART-FAILURE
  • ENDOTHELIUM
  • INFARCTION
  • VASOCONSTRICTION
  • VASODILATION
  • STIMULATION
  • RELEASE
  • HUMANS

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