Possibilities of correction of coronary and myocardial reserves in patients with ischemic heart disease by angiotensin converting enzyme inhibitor perindopril

Aim. Assessment of possibilities of correction of coronary and myocardial reserves in patients with ischemic heart disease (IHD) by angiotensin converting enzyme inhibitor perindopril included into combination antiischemic therapy. Material and methods. Antianginal and angioprotective effects of perindopril (8 mg/day) were studied in 37 patients (22 men, 15 women, mean age 62,2 +/- 5,3 years) with IHD and functional class (FC) I-III angina. Methods of control included assessment of severety of angina, 24-hour Holter ECG monitoring, bicycle exercise test, echocardiographical investigation at rest, stress-echocardiography (SEchoCG) with physical work load, investigation of endothelium dependent vasodilation of brachial artery (BA) and Doppler study of blood flow velocities. Duration of treatment was 6 weeks. Results. Antianginal effect of perindopril was noted in 73% of patients mostly with FC I-II with decrease of number of attacks per week by 11.3% (p<0.05). According to data of ECG monitoring number of episodes of myocardial ischemia per day diminished 19.3% (p<0.05), including 10.1% decrease of painless ("silent") episodes. Total duration of episodes of ischemia decreased 22.4% (p<0.05). According to results of veloergometry increase of total duration of work from 261.2 +/- 93,5 to 305.9 +/- 98.7 s (by 17.1%, p<0.05) was noted. EchoCG at rest revealed disturbances of local contractility of left ventricular (LV) myocardium (hypo- and akinesia) in 73%, sings of LV diastolic dysfunction - in 92% of patients (E/A=0.83). After therapy with perindopril improvement of local systolic LV function was noted: at rest and at exercise number of segments of hypokinesis decreased 11.3 (p<0.05) and 5.9% (p<0.05), respectively. In patients with initial signs of LV diastolic dysfunction prescription of perindopril led to significant 17.3% (p<0.05) increase of DE/A at rest. In 7 patients index E/A at rest normalized. Number of patients with endothelial dysfunction decreased 26 and 8% in angina FC I-II and III, respectively. in patients with FC I-II angina significant 9.8% increase (p<0.05) of BA diameter, increases of linear and volume blood flow velocities from 5.0 +/- 1.9 to 41.5 +/- 2.1 cm/s (p<0.05) and from c 2.1 +/- 0.5 to 6.9 +/- 0.5 ml/s (p<0.05), respectively, were noted. Conclusion. Perindopril in the dose of 8 mg/day in patients with IHD with stable effort angina FC I-III in combination antiischemic therapy exerts positive influence on the state of coronary and myocardial reserves of the heart and decreases degree of dysfunction of endothelium what denotes antianginal and vasoprotective effects of the drug. Enhancement of coronary blood flow leads to betterment of diastolic function of the myocardium in patients with disturbances of relaxation and to improvement of local contractility of the myocardium appearing as decrease of quantity of hypokinetic segments.