Abstract

Introduction: Polymorphism in the angiotensin-converting enzyme (ACE) gene has been reported to correlate with circulating ACE concentration levels and to be associated with myocardial infarction, sudden death, ischemic and idiopathic dilated cardiomyopathy, restenosis following percutaneous transluminal coronary angioplasty and left ventricular hypertrophy. In the present study, we investigated the potential association between the insertion/deletion (I/D) polymorphism of the ACE gene and left ventricular volumes and function in relatively young patients with an angiographically proven coronary heart disease. Material and Method: The study was performed on forty patients with an angiograpically confirmed CHD, all being younger than fifty years of age (mean age 44(4 years, 36 males and 4 females). Left ventricular volumes and function were measured during cardiac catheterisation. The PCR technique was used to determine the ACE I/D genotype. [E1] Results: Allele frequencies in our study group were 39% for the I allele and 61% for the D allele. The observed genotype distribution was as follows: II=7/40, ID=17/40 and DD=16/40 and was in agreement with the Hardy-Weinberg equilibrium (p=0.99). No significant differences between the genotype groups were found for the main variables: age, body mass index, total cholesterol, LDL fraction cholesterol, HDL fraction cholesterol, tryglicerides, smoking habits, positive myocardial infarction, hypertension and diabetes history. A significant correlation between the DD genotype and the deterioration in left ventricular function was observed in the studied population. The ejection fraction in subjects with the DD genotype was significantly lower than in patients with ID or II genotypes (48±15% vs. 63±12%, p<0.01). Left ventricular end-diastolic pressure reflecting left ventricular diastolic function was significantly higher in DD genotype patients as compared to the ID+II group (16.3±6.8 mmHg vs. 11.9±3.7 mmHg, p<0.05). The stoke volume index in subjects with the DD genotype was significantly smaller than in the II+ID group (39±13 ml/m2 vs. 52±17 ml/m2, p<0.05). Conclusion: Our present study supports the hypothesis that the DD genotype is a marker of impaired left ventricular function in relatively young patients with coronary heart disease

Keywords: angiotensin-converting enzyme gene, coronary heart disease, left ventricular function, I/D polymorphism