Endothelial dysfunction and reduced myocardial perfusion reserve in heart failure secondary to coronary artery disease

Patients with left ventricular dysfunction and normal B-type atrial natriuretic peptide (BNP) have endothelial dysfunction and a reduction in myocardial perfusion reserve comparable to patients with elevated BNP. Thus, left ventricular dysfunction is accompanied by endothelial dysfunction and a reduced myocardial perfusion reserve early in the progression of left ventricular dysfunction to heart failure

Impairment of myocardial blood flow reserve in patients with asymptomatic left ventricular dysfunction:Effects of ACE-inhibition with perindopril

Myocardial blood flow (MBF) reserve is impaired in patients with symptomatic chronic heart failure. Whether this is already present in asymptomatic left ventricular (LV) dysfunction, and whether it is affected by angiotensin converting enzyme (ACE) inhibition, is unknown. We examined MBF in 20 patients with asymptomatic LV dysfunction and compared them to healthy volunteers. MBF (reserve) was assessed with positron emission tomography (PET) and N-13 ammonia at rest, during dipyridamole stress test (DST) and during cold pressor test (CPT). Further, in the LV-dysfunction group, we studied the effects of 3 months treatment with ACE inhibition with a second PET study. Patients were randomized double-blind to perindopril 4 mg daily or placebo. MBF at rest was similar in controls and patients. DST-induced MBF reserve, however, was decreased in patients vs. controls (1.71 +/- 0.2 vs. 2.62 +/- 0.5, respectively p <0.05). Also CPT-induced MBF was lower in patients (1.14 +/- 0.06 vs. 1.23 +/- 0.03, p <0.05). After 3 months double-blind treatment, CPT-induced MBF decreased in the placebo group (from 1.12 +/- 0.02 to 0.93 +/- 0.06), but was preserved in the perindopril group (from 1.16 +/- 0.08 to 1.14 +/- 0.08 shifts from baseline: -0.19 +/- 0.05 vs. -0.02 +/- 0.07 respectively p = 0.07). This was compatible with a trend to a smaller increase in coronary vascular resistance during CPT (1.23 +/- 0.08 vs. 1.03 +/- 0.06, placebo vs. perindopril, p = 0.06). In patients with asymptomatic LV dysfunction, MBF, both after vasodilation and after CPT, is already impaired. ACE inhibition with perindopril during this short-term treatment had no significant effects