Circulation, Vol 88, 2277-2283, Copyright © 1993 by American Heart Association
MA Konstam, MW Kronenberg, MF Rousseau, JE Udelson, J Melin, D Stewart, N Dolan, TR Edens, S Ahn and D Kinan
BACKGROUND. Patients with heart failure and reduced left ventricular (LV)
ejection fraction (EF) manifest progressive LV dilatation, which is
prevented by angiotensin converting enzyme (ACE) inhibitors. In patients
with asymptomatic LV systolic dysfunction, in whom there is less activation
of the renin-angiotensin system, ventricular remodeling might be less rapid
and the benefit of ACE inhibitors less discernible. METHODS AND RESULTS.
One hundred eight patients enrolled in the Studies of Left Ventricular
Dysfunction (SOLVD) Prevention Trial, with left ventricular ejection
fraction < or = 0.35 but without clinical heart failure, underwent
radionuclide ventriculograms, and 49 underwent left heart catheterizations.
Measurements were made before and after double- blinded randomization to
enalapril (2.5 to 20 mg/d) or placebo. Repeated-measures analysis of all
time points showed significant differences for change in end-diastolic
volume (EDV) between enalapril and placebo groups. Significant difference
between the enalapril and placebo groups (P < .05) was present for
change in EDV at 1 year within the catheterization study and at a mean of
25 months within the radionuclide study. Radionuclide EDV increased in
placebo patients (119 +/- 28 to 124 +/- 33 mL/m2, mean +/- SD) and
decreased in enalapril patients (120 +/- 25 to 113 +/- 25 mL/m2).
Differences between the two groups were significantly less than previously
described in patients with symptomatic heart failure (P < .02), with
less increase in LV volumes in the placebo group and less decrease in
volumes in the enalapril group. CONCLUSIONS. Chronic ACE inhibitor
treatment slows or reverses LV dilatation in patients with asymptomatic LV
systolic dysfunction. Compared with symptomatic patients, asymptomatic
patients manifest a slower rate of spontaneous LV dilatation and less
reduction in LV volumes by enalapril.
ARTICLES
Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dilatation in patients with asymptomatic systolic dysfunction. SOLVD (Studies of Left Ventricular Dysfunction) Investigators
Department of Medicine, Tufts University, New England Medical Center, Boston, MA 02111.
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