Effects of perindopril on cardiac sympathetic nerve activity in patients with congestive heart failure: comparison with enalapril

  • Shu Kasama
  • Takuji Toyama
  • Hisao Kumakura
  • Yoshiaki Takayama
  • Shuichi Ichikawa
  • Tadashi Suzuki
  • Masahiko Kurabayashi
Original Article

DOI: 10.1007/s00259-005-1786-z

Cite this article as:
Kasama, S., Toyama, T., Kumakura, H. et al. Eur J Nucl Med Mol Imaging (2005) 32: 964. doi:10.1007/s00259-005-1786-z

Abstract

Purpose

The production of aldosterone in the heart is suppressed by the angiotensin-converting enzyme (ACE) inhibitor perindopril in patients with congestive heart failure (CHF). Moreover, perindopril has been reported to have more cardioprotective effects than enalapril.

Materials and methods

Forty patients with CHF [left ventricular ejection fraction (LVEF) <45%; mean 33±7%] were randomly assigned to perindopril (2 mg/day; n=20) or enalapril (5 mg/day; n=20). All patients were also treated with diuretics. The delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS) and washout rate (WR) were determined from 123I-meta-iodobenzylguanidine (MIBG) images, and plasma brain natriuretic peptide (BNP) concentrations were measured before and 6 months after treatment. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and LVEF were also determined by echocardiography.

Results

After treatment, in patients receiving perindopril, TDS decreased from 39±10 to 34±9 (P<0.01), H/M ratios increased from 1.62±0.27 to 1.76±0.29 (P<0.01), WR decreased from 50±14% to 42±14% (P<0.05) and plasma BNP concentrations decreased from 226±155 to 141±90 pg/ml (P<0.0005). In addition, the LVEDV decreased from 180±30 to 161±30 ml (P<0.05) and the LVESV decreased from 122±35 to 105±36 ml (P<0.05). Although the LVEF tended to increase, the change was not statistically significant (from 33±8% to 36±12%; P=NS). On the other hand, there were no significant changes in these parameters in patients receiving enalapril.

Conclusion

Plasma BNP concentrations, 123I-MIBG scintigraphic and echocardiographic parameters improved after 6 months of perindopril treatment. These findings indicate that perindopril treatment can ameliorate the cardiac sympathetic nerve activity and the left ventricular performance in patients with CHF.

Keywords

123I-MIBGHeart failureAngiotensin-converting enzyme inhibitor

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Shu Kasama
    • 1
  • Takuji Toyama
    • 1
  • Hisao Kumakura
    • 2
  • Yoshiaki Takayama
    • 2
  • Shuichi Ichikawa
    • 2
  • Tadashi Suzuki
    • 1
  • Masahiko Kurabayashi
    • 1
  1. 1.Department of Cardiovascular MedicineGunma University School of MedicineMaebashiJapan
  2. 2.Department of Internal MedicineCardiovascular Hospital of Central JapanGunmaJapan