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Progressive left ventricular hypertrophy after withdrawal of long-term ACE inhibition following experimental myocardial infarction.

Abstract：

BACKGROUND:Although discontinuation of chronic ACE inhibitor (ACEi) therapy after myocardial infarction (MI) is common in clinical practice, some clinical studies reported an increased incidence of ischemia-related events after withdrawal. To further address this issue, we assessed hemodynamic, neurohormonal and vascular consequences of withdrawing long-term ACEi treatment after experimental MI. METHODS:Rats were subjected to coronary ligation to induce MI, and received quinapril (15 mg/kg/day) from 2 weeks to 14 months post-MI. Subsequently, surviving rats were randomized to sacrifice at 0, 4, and 6 weeks after ACEi withdrawal. Rats were studied for signs of heart failure, hemodynamics and cardiac function, neurohormones, and vascular edothelial function. RESULTS:After discontinuation of ACEi treatment, plasma aldosterone levels increased between 0-4 weeks without further increment thereafter, suggesting persistent RAAS activation. Acetylcholine-induced aortic relaxation was impaired at 4 and 6 weeks, indicating rapid and sustained development of endothelial vasodilator dysfunction after withdrawal. Moreover, 24% of the rats developed heart failure signs (edema, dyspnea), and 3 rats died, all within 4 weeks after withdrawal. Significantly increased N-ANP levels and lung weights at 4, but not at 6 weeks suggest a transient volume overload. Finally, LV/body weight ratios significantly increased between 0-4 as well as 4-6 weeks, indicating progressive LV hypertrophy. CONCLUSIONS:The observed alterations after withdrawing long-term post-MI quinapril treatment in the present study may account for an increased risk for ischemic events. Thus, our findings highlight the potentially harmful effects associated with abrupt discontinuation of long-term post-MI ACE inhibition, and imply careful clinical consideration in this matter.

journal_name

Eur J Heart Fail

journal_title

European journal of heart failure

authors

Westendorp B,Schoemaker RG,Buikema H,Boomsma F,van Veldhuisen DJ,van Gilst WH

doi

10.1016/j.ejheart.2005.04.014

keywords:

subject

Has Abstract

pub_date

2006-03-01 00:00:00

pages

122-30

issue

eissn

1388-9842

issn

1879-0844

pii

S1388-9842(05)00111-X

journal_volume

pub_type

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Progressive left ventricular hypertrophy after withdrawal of long-term ACE inhibition following experimental myocardial infarction.