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

Abstract

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].

Keywords

Glycerine Ischemia Lactate Electrophoresis Coherence 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bishop SP, Altschuld RA (1971) Evidence for increased glycolytic metabolism in cardiac hypertrophy and congestive heart failure. In: Alpert NA (ed) Cardiac hypertrophy. Academic, New York, pp 567–585Google Scholar
  2. 2.
    Captopril Multicenter Research Group (1983) A placebo-controlled trial of captopril in refractory chronic congestive heart failure. J Am Coll Cardiol 2: 755–763Google Scholar
  3. 3.
    Cleland JGF, Dargie HJ, Ball SG, Gillen G, Hodsman GP, Morton JJ, East BW, Robertson I, Ford I, Robertson JIS (1985) Effects of enalapril in heart failure: a double blind study of effects on exercise performance, renal function, hormones, and metabolic state. Br Heart J 54: 305–312PubMedCrossRefGoogle Scholar
  4. 4.
    CONSENSUS Trial Study Group (1987) Effects of enalapril on mortality on severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 316: 1429–1435Google Scholar
  5. 5.
    Ertl G (1986) The effect of angiotensin I and II at normal and reduced coronary perfusion. Pflugers Arch 406 [Suppl]: R49Google Scholar
  6. 6.
    Everse J, Kaplan NO (1975) Mechanisms of action and biological functions of various dehydrogenase isoenzymes. In: Markert CL (ed) Isoenzymes. II. Physiological functions. Academic, New York, pp 29–43Google Scholar
  7. 7.
    Faxon DP, Creager MA, Halperin JL, Sussmann HA, Gavras H, Ryan TJ (1982) The effect of angiotensin converting enzyme inhibition on coronary blood flow and hemodynamics in patients without coronary artery disease. Int J Cardiol 2: 251–262PubMedCrossRefGoogle Scholar
  8. 8.
    Foult JM, Nitenberg A, Tovolaro O, Antony I (1987) Selective coronary vasodilator effect of enalaprilat in patients with dilated cardiomyopathy: demonstration by a bilateral intracoronary infusion technique. J Am Coll Cardiol 9: 192 AGoogle Scholar
  9. 9.
    Gerlings ED, Gilmore JP (1974) Evidence for myocardial conversion of angiotensin, part 1. Basic Res Cardiol 69: 222–227PubMedCrossRefGoogle Scholar
  10. 10.
    Goodwin JF (1974) Prospects and predictions for the cardiomyopathies. Circulation 50: 210–219PubMedGoogle Scholar
  11. 11.
    Halperin JL, Faxon DP, Creager MA, Bass TA, Melidossian CD, Gavras H, Ryan TJ (1982) Coronary hemodynamic effects of angiotensine inhibition by captopril and teprotide in patients with congestive heart failure. Am J Cardiol 50: 967–972PubMedCrossRefGoogle Scholar
  12. 12.
    Hasking GJ, Esler, MD, Jennings GL, Burton D, Johns JA, Korner PI (1986) Norepinephrine spillover to plasma in patients with congestive heart failure: evidence of increased overall and cardiorenal sympathetic nervous activity. Circulation 73: 615–621PubMedCrossRefGoogle Scholar
  13. 13.
    Holtz J, Busse R, Sommer O, Bassenge E (1987) Dilation of epicardial arteries in conscious dogs induced by angiotensin converting enzyme inhibition with enalaprilat. J Cardiovasc Pharmacol 9: 348–355PubMedCrossRefGoogle Scholar
  14. 14.
    Magrini F, Shimizu M, Roberts N, Fouad FM, Tarazi RC, Zanchetti A (1987) Convertingenzyme inhibition and coronary blood flow. Circulation 75 [Suppl I]: 168–174Google Scholar
  15. 15.
    McGrath BP, Arnolda L, Matthews PG et al. (1985) Controlled trial of enalapril in congestive cardiac failure. Br Heart J 54: 405–414PubMedCrossRefGoogle Scholar
  16. 16.
    Nadal-Ginard B, Markert CL (1975) Use of affinity chromatography for purification of lactate dehydrogenase and for assessing the homology and function of the A and B subunits. In: Markert CL (ed) Isoenzymes. II. Physiological functions. Academic, New York, pp 45–67Google Scholar
  17. 17.
    Nitenberg A, Foult JM, Blanchet F, Zouioueche S (1985) Multifactorial determinants of reduced coronary flow reserve after dipyridamole in dilated cardiomyopathy. Am J Cardiol 55: 748–754PubMedCrossRefGoogle Scholar
  18. 18.
    Schultheiss H-P, Bolte HD, Fischer S, Cyran J (1980) Enzymatic analysis and collagen content in endomyocardial biopsy samples of patients with congestive cardiomyopathy of unknown etiology. Clin Cardiol 3: 329–334PubMedCrossRefGoogle Scholar
  19. 19.
    Schultheiss H-P, Bispink G, Neuhoff V, Bolte HD (1981) Myocardial lactate dehydrogenase isoenzyme distribution in the normal heart. Basic Res Cardiol 76: 681–689PubMedCrossRefGoogle Scholar
  20. 20.
    Schultheiss H-P, Zähringer J, v. Scheidt W, Ulrich G (1986) Myocardial lactate dehydrogenase (LDH) isoenzyme distribution in chronic heart failure (CHF) before and after treatment with enalapril. Circulation 74 [Suppl II]: 508Google Scholar
  21. 21.
    Strauer BE (1987) Cardiac energetics in clinical heart disease. In: Jacob R, Just HJ, Holubarsch C (eds) Cardiac energetics. Steinkopff, Darmstadt; Springer, New YorkGoogle Scholar
  22. 22.
    Unverferth DV, Magorien RD, Lewis RP, Leier CV (1983) The role of subendocardial ischemia in perpetuating myocardial failure in patients with nonischemic congestive cardiomyopathy. Am Heart J 105: 176–179PubMedCrossRefGoogle Scholar
  23. 23.
    Weber KT, Janicki JS, Campbell C, Replogle R (1987) Pathophysiology of acute and chronic heart failure. Am J Cardiol 60: 3c–9cPubMedCrossRefGoogle Scholar
  24. 24.
    Weiss MB, Ellis K, Sciacca RR, Johnson LL, Schmidt DH, Cannon PJ (1976) Myocardial blood flow in congestive and hypertrophic cardiomyopathy. Relationship to peak wall stress and mean velocity of circumferential fiber shortening. Circulation 54: 484–494PubMedGoogle Scholar
  25. 25.
    Xiang J-Z, Linz W, Becker H, Ganten D, Lang RE, Scholkens B, Unger TH (1985) Effects of converting enzyme inhibitors: ramipril and enalapril on peptide action and sympathetic neurotransmission in the isolated heart. Eur J Pharmacol 113: 215–223PubMedCrossRefGoogle Scholar

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

Personalised recommendations