Effect of Angiotensin-Converting Enzyme Inhibitors on Energy Metabolism in Chronic Heart Failure - Enzymatic Studies of Myocardial Biopsies

  • K. Schulze
  • M. Schindler
  • H.-P. Schultheiss


Severe chronic heart failure is characterized by poor systolic function with low cardiac output, increased systolic and diastolic volumes, augmented diastolic pressures and ventricular hypertrophy secondary to cavity dilatation [10, 22, 23]. The myocardial oxygen demand is heightened due to wall stress, myocardial contractility and heart rate [21, 24]. However, the oxygen supply, at least to the subendocardium, is inadequate, which is caused by decreased coronary blood flow, an increased intramyocardial vascular resistance by elevated filling pressures and a shortened diastolic perfusion time [17, 24]. There is evidence that progressive deterioration of the heart is due to the inadequate coronary blood flow to the subendocardium, leading to decreased oxygen delivery to this area with a resultant loss of its ability to contribute to the work of the heart. Thus the imbalance between myocardial oxygen supply and demand might initiate a vicious cycle that worsens heart failure and further decreases coronary blood flow [1, 22].


Chronic Heart Failure Angiotensin Converting Enzyme Inhibitor Coronary Blood Flow Rate Pressure Product Severe Chronic Heart Failure 
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Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • K. Schulze
    • 1
  • M. Schindler
    • 1
  • H.-P. Schultheiss
    • 1
  1. 1.Department of Internal Medicine, Klinikum GroßhadernUniversity of MunichMünchen 70Germany

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