Circulation, Vol 90, 3034-3046, Copyright © 1994 by American Heart Association
KM McDonald, M Garr, PF Carlyle, GS Francis, K Hauer, DW Hunter, T Parish, A Stillman and JN Cohn
BACKGROUND: Progressive ventricular remodeling after myocardial damage is
associated with a poor prognosis. Optimal prevention of the
histopathological processes involved in remodeling requires a more complete
understanding of the mechanisms involved in initiating and maintaining
these structural changes. Since the sympathetic nervous system and the
renin-angiotensin system may be involved in the remodeling process, the
structural effects of pharmacological inhibitors have been evaluated in a
canine model of localized myocardial injury resulting from transmyocardial
DC shock. METHODS AND RESULTS: The study is comprised of two protocols run
in series. In protocol 1, zofenopril (Z), a converting enzyme inhibitor
(CEI), prevented the increase in left ventricular mass (LVM) and
end-diastolic volume (LVV) observed in the control group (C) at 16 weeks
(Z: LVM, 69.8 +/- 3.4 to 65.4 +/- 2.6 g, P = NS; LVV, 45.4 +/- 2.7 to 51.6
+/- 2.7 mL, P = NS; C: LVM, 68.4 +/- 3.2 to 91.4 +/- 2.9 g, P = .0001; LVV,
56.6 +/- 3.0 to 71.9 +/- 2.4 mL, P = .0003). Terazosin, an alpha 1-
adrenoceptor antagonist, failed to prevent remodeling at 16 weeks despite
continued receptor blockade. In protocol 2, the antiremodeling effect of
full-dose CEI therapy with ramipril was confirmed. Low-dose ramipril that
exerted no hemodynamic effect failed to prevent remodeling (LVM, 89.7 +/-
4.6 to 105.7 +/- 3.4 g, P = .01; LVV, 61.8 +/- 3.8 to 76.8 +/- 3.3 mL, P =
.002). An angiotensin II subtype 1 receptor blocker also failed to prevent
the increase in LVM or LVV (LVM, 89.0 +/- 4.6 to 109.7 +/- 5.3 g, P =
.0001; LVV, 66.0 +/- 1.9 to 78.4 +/- 3.6 mL, P = .007). CONCLUSIONS:
High-dose CEI therapy can prevent progressive structural changes resulting
from localized myocardial damage induced by DC shock. the failure of alpha
1-adrenoceptor blockade and angiotensin II subtype 1 blockade to attenuate
remodeling argues against an important direct role for norepinephrine
acting through alpha 1-receptors or angiotensin II acting through the type
1 receptor in the remodeling process in this model.
ARTICLES
Relative effects of alpha 1-adrenoceptor blockade, converting enzyme inhibitor therapy, and angiotensin II subtype 1 receptor blockade on ventricular remodeling in the dog
Department of Medicine, University of Minnesota Medical School, Minneapolis 55455.
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