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Effects of captopril on myocardial protection during cardioplegia
P Di Pasquale1, S Paterna, M Valenza
1Department of Cardiology, G.F. Ingrassia Hospital, Palermo, Italy.
Insights
This study investigated captopril
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Biochemistry
Background:
- Coronary artery disease and acute myocardial infarction (AMI) pose significant risks.
- Cardioplegia during aorto-coronary-by-pass (CABG) surgery aims to reduce myocardial damage.
- The role of tissue angiotensin-converting enzyme (ACE) inhibition in mitigating reperfusion injury is under investigation.
Purpose of the Study:
- To evaluate the effects of captopril on the human myocardial ACE system during CABG.
- To determine if tissue ACE inhibition by captopril can reduce reperfusion damage in patients with AMI.
Main Methods:
- A double-blind, randomized study involving 54 patients undergoing CABG for 3-vessel coronary artery disease and anterior AMI.
- Captopril was added to the cardioplegic solution (4 mg/l) or placebo was administered.
- Blood and perfusate samples were collected at 8 time points for analysis of Angiotensin I, norepinephrine, epinephrine, and creatine kinase (CK).
Main Results:
- Angiotensin I levels showed no significant difference between the captopril and placebo groups across the 8 sampling points.
- While specific values varied, the overall trend did not demonstrate a statistically significant impact of captopril on Angiotensin I concentrations.
- Further analysis of catecholamines and CK is needed to fully assess captopril's effects.
Conclusions:
- Captopril administration within the cardioplegic solution did not significantly alter Angiotensin I levels in patients undergoing CABG.
- The study did not provide evidence for significant tissue ACE inhibition by captopril in this specific surgical context.
- Further research is warranted to explore alternative methods or dosages for achieving ACE inhibition during cardiac surgery.
Unlabelled:
The study aimed at checking effects exerted by captopril (C) on human myocardial ACE system as well as the role played by tissue ACE inhibition in reducing reperfusion damage. A human experimental model was used during cardioplegia due to aorto-coronary-by-pass (CABG). Fifty-four patients with coronary artery disease affecting 3 vessels having suffered from acute myocardial infarction anterior (AMI-ant), homogeneous as far as ejection fraction (35-55%), number of grafts (3), clamping time, age and sex, were randomised in a double blind experiment, and were given captopril or placebo (P). A total of 4 mg/l Captopril was mixed into the cardioplegic solution with blood according to the method of Buckberg (Buckberg GD. J Thorac Cardiovasc Surg 1987; 93: 127-139). Eight samples (blood/perfusate) were obtained from each patients and norepinephrine (NE), epinephrine (E) were assayed using an HPLC technique. Angiotensin I was assayed by RIA. CK was also assayed (units/ml). Blood/perfusate samples were taken during CABG: (1) pre-pump; (2) pump sample; (3) pump preclamping; (4) coronary sinus; (5) coronary sinus sample during reperfusion; (6) coronary sinus during warm reperfusion; (7) after clamping sample; (8) after decanulation;
Results:
Captopril group (29 patients): angiotensin I: (1) 8.15; (2) 7.0; (3) 7.31; (4) 8.45; (5) 8.93; (6) 8.73; (7) 9.07; (8) 9.40; versus placebo: (1) 7.09, (2) 7.43; (3) 7.80; (4) 9.31; (5) 9.01; (6) 8.35; (7) 8.85; (8) 8.07 ng/ml, probability, not significant.(ABSTRACT TRUNCATED AT 250 WORDS)