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European Heart Journal 1989 10(Supplement F):97-100; doi:10.1093/eurheartj/10.suppl_F.97
Copyright © 1989 by the European Society of Cardiology.
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© 1989 The European Society of Cardiology

Coronary vasodilation induced by intracoronary enalaprilat: an argument for the role of a local renin-angiotensin system in patients with dilated cardiomyopathy

J.-M. Foult, O. Tavolaro, I. Antony and A. Nitenberg

Chu Xavier Bichat Paris, France

Address for reprints: Jean-Marc Foult, M.D., CHU Xavier Bichat, Service d'Explorations Fonctionnelles, INSERM U.251, 16–46, rue Henri Huchard, F-75877 Paris Cedex 18, France

Although indicated by several experimental studies, the presence of a renin-angiotensin system has not been demonstrated in the human heart. The influence of a local renin-angiotensin system on the coronary vessels may be difficult to establish after oral or intravenous administration of an angiotensin converting-enzyme inhibitor, since coronary blood flow depends greatly on the loading conditions of the left ventricle.

To avoid such a situation, our study consisted in a direct bilateral intracoronary infusion of enalaprilat in patients with dilated cardiomyopathy and normal coronary arteries (mean ejection fraction =32±11%, n=12). This intracoronary infusion (0·05mg min–1, 1 ml min–1 in each coronary artery) resulted in no significant change of the systemic resistances (20·6±5·6 to 22·0±5·1 mmHg l–1 min), rate-pressure product (10974±2630 to 10214±2486) or myocardial oxygen consumption (21·08±6·37 to 22·10±6·42ml min–1). Despite these steady haemodynamic conditions, intracoronary enalaprilat provoked a significant elevation of coronary sinus blood flow (181±73 to 214± 79ml min–1, P<0·001) with a reduction of coronary resistance (0·51±0·17 to 0·41±0·15rnmHgml–1 min, P<0·001), and no significant alteration in plasma renin activity or plasma aldosterone.

The results of this intracoronary infusion of enalaprilat demonstrate that this angiotensin converting-enzyme inhibitor has significant coronary vasodilator properties, which can be evidenced without stimulating the peripheral renin-angiotensin system. Since large epicardial coronary vessels account for little of the coronary resistance, this action of enalaprilat in patients with dilated cardiomyopathy is likely to take place at the coronary arteriolar level, which appears to be a target organ for a myocardial renin-angiotensin system.

Key Words: Converting-enzyme inhibitors • coronary circulation


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