Acute anti-ischemic effects ef perindoprilat in men with coronary artery disease and their relation with left ventricular function

Long-term angiotensin-converting enzyme (ACE) inhibition may reduce ischemi c events in patients with coronary artery disease, but whether it protects against acute ischemia or the effects of preexisting left ventricular (LV) dysfunction on potential anti-ischemic properties is unknown. We performed a double-blind trial in 25 patients with exercise-induced ischemia. The eff ects of perindoprilat on pacing-induced myocardial ischemia were examined. Fourteen patients received perindoprilat and 11 patients received placebo. Based on LV function, 2 subgroups were formed in the perindoprilat group: 7 patients with LV dysfunction (LV ejection fraction <0.40), and 7 patients with normal LV function. After receiving the study medication, the pacing t est was repeated. During the first pacing test bath groups developed ischem ia. After perindoprilat administration, the increase in systemic vascular r esistance and LV end-diastolic pressure were significantly blunted (p < 0.0 5). Further, the ischemia- induced increase in arterial and cardiac uptake of norepinephrine was inhibited by per indoprilat, and the increase in atri al natriuretic peptide was less pronounced; also, ST-segment depression was reduced by 32% compared with placebo (all p < 0.05). In the group with LV dysfunction, perindoprilat reduced LV end-diastolic pressure significantly by 67% and myocardial lactate production was prevented, but this did nor ha ppen in the group with normal LV function. In addition, the increase in art erial norepinephrine was reduced by 74% and 33%, respectively (p < 0.05). T hese results indicate that perindoprilat reduced acute, pacing-induced isch emia in normotensive patients. In patients with (asymptomatic) LV dysfuncti on these effects were more pronounced than in patients with normal LV funct ion. (C)1999 by Excerpta Medica, Inc.