Affiliation:
1. From the Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, and the Pharmaceutical Division, Novartis, Basel, Switzerland (M. de G., S.W.)
Abstract
Background
The goal of this study was to determine the effects of ACE inhibition (ACEI) alone, AT
1
angiotensin (Ang) II receptor blockade alone, and combined ACEI and AT
1
Ang II receptor blockade on LV function, systemic hemodynamics, and neurohormonal system activity in a model of congestive heart failure (CHF).
Methods and Results
Pigs were randomly assigned to each of 5 groups: (1) rapid atrial pacing (240 bpm) for 3 weeks (n=9), (2) ACEI (benazeprilat, 0.187 mg · kg
−1
· d
−1
) and rapid pacing (n=9), (3) AT
1
Ang II receptor blockade (valsartan, 3 mg · kg
−1
· d
−1
) and rapid pacing (n=9), (4) ACEI and AT
1
Ang II receptor blockade (benazeprilat/valsartan, 0.05/3 mg · kg
−1
· d
−1
) and rapid pacing (n=9), and (5) sham controls (n=10). In the pacing group, LV fractional shortening (LVFS) fell (13.4±1.4% versus 39.1±1.0%) and end-diastolic dimension (LVEDD) increased (5.61±0.11 versus 3.45±0.07 cm) compared with control (
P
<.05). With AT
1
Ang II blockade and rapid pacing, LVEDD and LVFS were unchanged from pacing-only values. ACEI reduced LVEDD (4.95±0.11 cm) and increased LVFS (20.9±1.9%) from pacing-only values (
P
<.05). ACEI and AT
1
Ang II blockade reduced LVEDD (4.68±0.07 cm) and increased LVFS (25.2±0.9%) from pacing only (
P
<.05). Plasma norepinephrine and endothelin increased by more than fivefold with chronic pacing and remained elevated with AT
1
Ang II blockade. Plasma norepinephrine was reduced from pacing-only values by more than twofold in the ACEI group and the combination group. ACEI and AT
1
Ang II receptor blockade reduced plasma endothelin levels by >50% from rapid-pacing values.
Conclusions
These findings suggest that the effects of ACEI in the setting of CHF are not solely due to modulation of Ang II levels but rather to alternative enzymatic pathways and that combined ACEI and AT
1
Ang II receptor blockade may provide unique benefits for LV pump function and neurohormonal systems in the setting of CHF.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
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