Haemorheological and endothelial‐dependent alterations in heart failure after ACE inhibitor,calcium antagonist and β blocker

Abstract

The aim of our study was to evaluate endothelium‐dependent dilatation induced by an ACE‐inhibitor, calcium antagonist and β blocker in patients suffering from heart failure (NYHA class II and III). We studied 34 patients (19M, 15F, mean age 76.96±8.82) in pharmacological wash‐out for at least one week, divided into 3 groups: Group A (15 patients, 9M and 6F) taking ramipril (5 mg/die); Group B (10 patients, 6M and 4F) taking amlodipine (10 mg/die), Group C: (9 patients, 4M and 5F) taking carvedilole (25 mg/die). The groups were homologous for NYHA class and instrumental echographic parameters (mean EF=22.5±6.7 and mean sAPP 38.4±8.7). At the beginning and after 3 weeks of therapy, we performed a clinical and instrumental assessment; we studied endothelial function by determination of L‐arginine and L‐citrulline (amino acids of the nitric oxide metabolic pathway), the L‐citrulline/L‐arginine ratio (an index of NOS activity) and VCAM‐1 (endothelial dysfunction index); haemorheological parameters (blood viscosity, plasma fibrinogen and erythrocyte morphology); coagulative/fibrinolytic parameters (PT, aPTT, fibrinogen and PAI‐1). The results show that L‐citrulline and L‐arginine increase, while VCAM‐1 decreases. The L‐citrulline/L‐arginine ratio increases in a statistically significant way. This trend is maintained in each group. These results demonstrate that the drugs used induce an improvement of endothelium‐dependent dilatation. In addition, there is progressive haemorheological and fibrinolytic improvement, with a reduction of PAI‐1 and blood viscosity.