ANGIOTENSIN AS LOCAL MODULATING FACTOR IN VENTRICULAR DYSFUNCTION ANDFAILURE DUE TO CORONARY-ARTERY DISEASE

Congestive heart failure is the end product of a progressive series of events resulting from acute myocardial damage. Circulatory neurohormo nal systems are activated during the acute phase of left ventricular d ysfunction resulting from initial myocardial damage and again in the l atter phase of decompensated heart failure. However, these neurohormon al mechanisms return to normal during the compensated stage of heart f ailure. Recent studies have suggested that autocrine/paracrine modulat ors of cardiovascular function are activated in the preclinical phase preceding the development of overt heart failure. The renin-angiotensi n system in particular has been shown to modulate many of the chronic processes involved in the pathophysiology of cardiovascular disorders. Recent studies suggest that locally generated angiotensin II may cont ribute to the secondary structural changes seen in cardiovascular diso rders, such as cardiac hypertrophy and remodelling, coronary artery di sease, and atherosclerosis. Thus, inhibition of angiotensin formation with angiotensin converting enzyme (ACE) inhibitors, particularly at t he tissue level, may provide valuable cardioprotective effects. Additi onal evidence points to the efficacy of ACE inhibitors in preventing t he progression of asymptomatic left ventricular dysfunction to overt h eart failure.