ulmonary arterial hypertension (PAH) is a disorder induced by various causes, such as collagen or pulmonary obstructive/restrictive disease-associated vasculopathy, pulmonary artery embolism, hypoxia, and inflammatory diseases, as well as genetic abnormalities. 1,2 Although the etiology of PAH is diverse, the essential pathophysiology is an elevation in the resistance of the pulmonary arteries characterized by vascular remodeling and smooth muscle spasm with continuous progression of luminal obliteration. Therefore, the strategy for treating PAH patients has focused on decreasing the resistance of the pulmonary arteries and/or preventing progression of pulmonary vascular remodeling. So far, vasodilatation therapy with Ca 2+ antagonists and prostaglandin derivatives has been used for PAH patients, but the improvement of prognosis and/or quality of life (QOL) has been limited. Recently, several clinical trials have revealed that an endothelin (ET)-1 receptor blocker, bosentan, is the most promising drug for the treatment of PAH, 3-5 and evidence for a beneficial effect of a phosphodiesterase V inhibitor, sildenafil, has accumulated, 6-9 with the Food and Drug Administration in the United States approving sildenafil as treatment for PAH in June 2005. However, these treatment strategies have not always been satisfactory for all PAH patients because of incomplete reversibility of the pulmonary vasculopathy, and the long-term benefits and side effects are not yet defined. The management of right ventricular failure should be considered together with treatment for pulmonary vasculopathy.Many recent clinical mega-trials have clearly shown that angiotensin-converting enzyme (ACE) inhibitors/angiotensin (AT) II receptor blockers (ARB) 10,11 and -adrenergicreceptor blockers (BB) 12-14 are beneficial drugs for patient with left-sided heart failure. Mechanical stress is an important factor in the progression of left ventricular (LV) hypertrophy/failure. In addition, circulating and/or locally produced ATII and catecholamines are now thought to directly contribute to LV remodeling and progression of hypertrophy/failure. However, it is a matter of debate whether the LV is affected by such neurohumoral factors in isolated right-sided heart failure due to PAH. The effect of ACE Background Left ventricular remodeling might be involved in the pathophysiology of right ventricular hypertrophy/failure due to pulmonary arterial hypertension (PAH), while the left ventricle is considered not under pressure/volume overload.
Methods and ResultsRats with monocrotaline-induced PAH were used in the present study to examine whether upregulated neurohumoral factors may induce left ventricular (LV) remodeling and(/or) contribute to prognosis. Morphological analysis revealed a significant increase in the weight of the free walls of both ventricles and the interventricular septum, indicating biventricular hypertrophy, although systemic blood pressure was not elevated. RNase protection assay demonstrated the activation of a fetal gene program in t...