Abstract
Animal studies have shown angiotensin converting enzyme (ACE) inhibitors to be effective agents for myocardial protection. They protect against lethal arrhythmias, preserve ventricular function, improve coronary reserve (especially after ischemia/reperfusion), and reverse myocardial hypertrophy. Human studies, on the other hand, have shown inconsistent results. The beneficial effects of ACE inhibitors demonstrated in animal studies provide major advantages for cardiac surgery. First, most cardiac surgery is performed under ischemic arrest induced by a cardioplegic solution, and the protective effects of ACE inhibition against reperfusion injury can reduce peri-operative mortality and morbidity. Second, most patients who undergo such surgery have myocardial hypertrophy due to hypertension, pressure or volume overload mediated by valve disease, or myocardial infarction. Ventricular hypertrophy is a strong risk factor for sudden death, probably from arrhythmia. Regression of the hypertrophy may prevent post-operative sudden death, thereby allowing for long-term benefits of surgery. In this paper, I review ACE inhibitor studies in animals and humans and the protective mechanisms involved. I also discuss why human studies show inconsistent results in spite of the fact that ACE inhibition is consistently protective in animal studies. Finally, I explore the potential clinical applications of ACE inhibitors in cardiac surgery.
Keywords: ACE inhibitor, myocardial protection, heart surgery, hypertrophy, review
Current Pharmaceutical Design
Title: Does Angiotensin Converting Enzyme Inhibitor Protect the Heart in Cardiac Surgery? From Laboratory to Operating Room: Clinical Application of Experimental Study
Volume: 12 Issue: 4
Author(s): Yasuyuki Shimada
Affiliation:
Keywords: ACE inhibitor, myocardial protection, heart surgery, hypertrophy, review
Abstract: Animal studies have shown angiotensin converting enzyme (ACE) inhibitors to be effective agents for myocardial protection. They protect against lethal arrhythmias, preserve ventricular function, improve coronary reserve (especially after ischemia/reperfusion), and reverse myocardial hypertrophy. Human studies, on the other hand, have shown inconsistent results. The beneficial effects of ACE inhibitors demonstrated in animal studies provide major advantages for cardiac surgery. First, most cardiac surgery is performed under ischemic arrest induced by a cardioplegic solution, and the protective effects of ACE inhibition against reperfusion injury can reduce peri-operative mortality and morbidity. Second, most patients who undergo such surgery have myocardial hypertrophy due to hypertension, pressure or volume overload mediated by valve disease, or myocardial infarction. Ventricular hypertrophy is a strong risk factor for sudden death, probably from arrhythmia. Regression of the hypertrophy may prevent post-operative sudden death, thereby allowing for long-term benefits of surgery. In this paper, I review ACE inhibitor studies in animals and humans and the protective mechanisms involved. I also discuss why human studies show inconsistent results in spite of the fact that ACE inhibition is consistently protective in animal studies. Finally, I explore the potential clinical applications of ACE inhibitors in cardiac surgery.
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Cite this article as:
Shimada Yasuyuki, Does Angiotensin Converting Enzyme Inhibitor Protect the Heart in Cardiac Surgery? From Laboratory to Operating Room: Clinical Application of Experimental Study, Current Pharmaceutical Design 2006; 12 (4) . https://dx.doi.org/10.2174/138161206775474413
DOI https://dx.doi.org/10.2174/138161206775474413 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
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