[Polymorphism of the ACE gene, structural-functional state of the left ventricle in patients with post-infarction cardiac failure and effects of the ACE-inhibitor Perindopril].

AIM

To evaluate relationships between structural-functional state of the left ventricle (LV) and genotype of angiotensin converting enzyme (ACE) gene in patients with postinfarction chronic cardiac failure (CCF) and effects of ACE inhibitor perindopril on hemodynamics depending on ACE gene polymorphism.

MATERIAL AND METHODS

In 52 patients with CCF (functional class III-IV by NYHA criteria) who had survived macrofocal myocardial infarction we studied ACE gene using thermostable DNA-polymerase Taq. Isolation of genome DNA from human venous blood was made by phenolchloroform extraction with the use of chelate polymer Chelex-100. Polymerase chain reaction was conducted on amplificator PHC-2 or PolyChain II. LV contractile function was studied on echocardiograph "Toshiba SSH-160A (Japan). Echocardiography was performed before intake of perindopril, in the end of titration phase, on therapy month 6 and 12.

RESULTS

Genotype II of ACE gene was detected in 11(21.1%) patients, ID genotype--in 20(38.5%), DD genotype--in 21(40.4%). Patients with ACE gene genotype II and ID have no differences by parameters of central hemodynamics. They were divided into two groups: group 1--patients with genotypes II and ID of ACE gene, group 2--patients with genotype DD. End diastolic volume (EDV), end systolic volume (ESV), index of LV myocardial mass were significantly less in group 1 than in group 2 (by 45.7, 81.6 and 31.2%, respectively). In group 1 ejection fraction (EF) and %delta S were higher by 35.3 and 35.7%, respectively. The hemodynamic effect of perindopril was higher in group 2. A month therapy resulted in a 8.7 and 14.8% reduction in group 2 EDV and ESV, respectively (p < 0.05). This entailed an increase in EF and %delta S by 18.3% (p < 0.05) and 19.8% (p < 0.05). Later, perindopril retained influence on central hemodynamics. Diastolic function to the end of therapy in both groups differed insignificantly.

CONCLUSION

In CCF patients functional class III-IV with the history of myocardial infarction, structural-functional LV parameters depend on genotype of ACE gene. Perindopril is most effective in DD-genotype of ACE gene.