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.
Export Options
About this article
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 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
New Generation Calcium Channel Blockers in Hypertensive Treatment
Current Hypertension Reviews Is there Evidence to Support the Use of Direct Factor Xa Inhibitors in Coronary Artery Disease?
Reviews on Recent Clinical Trials Editorial (Thematic Issue: Modifying Cardiovascular Risk Factors: Current Opinion and Future Trends)
Current Pharmaceutical Design Histamine and Histaminergic Receptors in Colorectal Cancer: From Basic Science to Evidence-based Medicine
Anti-Cancer Agents in Medicinal Chemistry New Pathways for Reactive Oxygen Species Generation in Inflammation and Potential Novel Pharmacological Targets
Current Pharmaceutical Design Therapeutic Use of Snake Venom Components: A Voyage from Ancient to Modern India
Mini-Reviews in Organic Chemistry The Role of Intracellular 35-Cyclic Adenosine Monophosphate (cAMP) in Atherosclerosis
Current Vascular Pharmacology Mitochondria as a Target for Exercise-Induced Cardioprotection
Current Drug Targets Mitochondrial Mutations in Atherosclerosis: New Solutions in Research and Possible Clinical Applications
Current Pharmaceutical Design Recent Advances Using Phosphodiesterase 4 (PDE4) Inhibitors to Treat Inflammatory Disorders: Animal and Clinical Studies
Current Drug Therapy Differential Regulation of microRNAs in Patients with Ischemic Stroke
Current Neurovascular Research Role of Iron Deficiency and Overload in the Pathogenesis of Diabetes and Diabetic Complications
Current Medicinal Chemistry Regenerative Medicine: Does Erythropoietin have a Role?
Current Pharmaceutical Design Cellular Therapy of Lysosomal Storage Disorders: Current Status and Future Prospects
Current Pediatric Reviews Apoptotic and Anti-Angiogenic Effects of Benzimidazole Compounds: Relationship with Oxidative Stress Mediated Ischemia/Reperfusion Injury in Rat Hind Limb
Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry Adaptors in Toll-Like Receptor Signaling and their Potential as Therapeutic Targets
Current Drug Targets Role of Thrombin Activatable Fibrinolysis Inhibitor in Endocrine and Cardiovascular Disorders: An Update
Recent Patents on Endocrine, Metabolic & Immune Drug Discovery Radial vs Femoral Approach in Acute Coronary Syndromes: A Meta- Analysis of Randomized Trials
Current Vascular Pharmacology Does Erythropoietin Always Win?
Current Medicinal Chemistry Kidney Injury Molcule-1 in Acute and Chronic Kidney Disease
Recent Patents on Biomarkers