PMID- 1827977
OWN - NLM
STAT- MEDLINE
DCOM- 19910625
LR  - 20131121
IS  - 0300-8428 (Print)
IS  - 0300-8428 (Linking)
VI  - 86 Suppl 1
DP  - 1991
TI  - Energetic consequences of substances currently used or recommended for long-term 
      treatment of chronic heart failure.
PG  - 107-12
AB  - Vasodilators have been shown to improve hemodynamics of the failing heart as a 
      short-term effect, and to decrease mortality as a long-term result. We, 
      therefore, studied the effects of vasodilators and inotropic agents on myocardial 
      mechanics and energetics in patients with congestive heart failure New York Heart 
      Association (NYHA) classes II-III. In these patients, who underwent routine heart 
      catheterization, myocardial oxygen consumption was measured using the argon 
      method, and LV pressure and geometry were obtained from LV angiography using a 
      Millar microtipped catheter. All data were analyzed for one single heart beat. 
      The best correlation was found between MVO2/beat and the systolic stress-time 
      integral which considers LV pressure, LV wall thickness, and LV geometry. The 
      relation between MVO2/beat and peak systolic wall stress was less relevant. No 
      correlation was found between MVO2/beat and pressure-volume work, dP/dtmax, and 
      mean velocity of circumferential fiber shortening. The intravenous application of 
      nitroprusside and the ACE-inhibitor benazepril decreased both the systolic 
      stress-time integral and the myocardial oxygen consumption in proportion to each 
      other, indicating unchanged economy of myocardial contraction. In contrast, beta 
      1-agonists and phosphodiesterase inhibitors increased myocardial oxygen 
      consumption independently of changes in the stress-time integral. In conclusion, 
      vasodilators decrease LV pressure and chamber size and thereby proportionally 
      reduce MVO2/beat. The reduction of energy needed for myocardial contraction may 
      partially explain the long-term effects of the ACE-inhibitors and combinations of 
      vasodilators. Pure inotropic substances, especially beta 1-agonists, increase 
      myocardial oxygen consumption with only minor changes of systolic stress-time 
      integral.(ABSTRACT TRUNCATED AT 250 WORDS)
FAU - Holubarsch, C
AU  - Holubarsch C
AD  - Department of Cardiology, Medizinische Universitatsklinik Freiburg.
FAU - Hasenfuss, G
AU  - Hasenfuss G
FAU - Thierfelder, L
AU  - Thierfelder L
FAU - Just, H
AU  - Just H
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Basic Res Cardiol
JT  - Basic research in cardiology
JID - 0360342
RN  - 0 (Benzazepines)
RN  - 0 (Cardiotonic Agents)
RN  - 0 (Imidazoles)
RN  - 0 (Propanolamines)
RN  - 0 (Vasodilator Agents)
RN  - 169D1260KM (Nitroprusside)
RN  - 7HE0JQL703 (Xamoterol)
RN  - C7Z4ITI7L7 (Enoximone)
RN  - UDM7Q7QWP8 (benazepril)
SB  - IM
MH  - Benzazepines/pharmacology
MH  - Cardiotonic Agents/*pharmacology
MH  - Energy Metabolism/drug effects
MH  - Enoximone
MH  - Heart Failure/*drug therapy/metabolism/physiopathology
MH  - Hemodynamics/drug effects
MH  - Humans
MH  - Imidazoles/pharmacology
MH  - Myocardium/metabolism
MH  - Nitroprusside/pharmacology
MH  - Oxygen Consumption/drug effects
MH  - Propanolamines/pharmacology
MH  - Vasodilator Agents/*pharmacology
MH  - Xamoterol
EDAT- 1991/01/01 00:00
MHDA- 1991/01/01 00:01
CRDT- 1991/01/01 00:00
PHST- 1991/01/01 00:00 [pubmed]
PHST- 1991/01/01 00:01 [medline]
PHST- 1991/01/01 00:00 [entrez]
PST - ppublish
SO  - Basic Res Cardiol. 1991;86 Suppl 1:107-12.