Effect of Angiotensin-Converting Enzyme Inhibitors on Energy Metabolism in Chronic Heart Failure - Enzymatic Studies of Myocardial Biopsies
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].
KeywordsGlycerine Ischemia Lactate Electrophoresis Coherence
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