Pressure relaxation of the left ventricle and filling pressures.

going dobutamine-stress (2). However, the PET technique enabled us to detect very early changes in myocardial blood flow before these clinical signs of ischemia eventually developed. Since we know that the presence of clinical signs of ischemia are inconsistent, subjective and variable in the same patient, we decided to focus on quantifiable, regional measures of myocardial blood flow. In contrast to Dr. Langobardi’s statement, there are data about the anti-ischemic effect of quinapril on clinical variables of myocardial ischemia in patients with coronary artery disease. Bussmann et al. (3) have previously reported the results of a randomized, double-blind, cross-over study of 16 men with coronary artery disease receiving oral quinapril or placebo. They were able to show that quinapril (10 mg) lead acutely, and after two weeks of treatment, to a significant reduction in the extent of ST depression during exercise electrocardiogram. Taken together these data indicate that quinapril has an antiischemic potential. However, we agree with Dr. Langobardi and have this clearly stated in our paper, that we do not treat myocardial blood flow values but patients with coronary artery disease. Therefore, the unique, anti-ischemic potential of quinapril in the treatment of patients with coronary artery disease must be substantiated in large clinical trials. From our data quinapril seems to be a promising choice for such studies.