(Circulation. 1997;95:2607-2609.)
© 1997 American Heart Association, Inc.
Articles |
Plasma Angiotensin-Converting Enzyme Activity and Left Ventricular Dilation After Myocardial Infarction
From the Department of Clinical Pharmacology (M.O., A.A.V., Y.M.P., W.H. van G.), University of Groningen, the Netherlands; Department of Cardiology (M.O., A.A.V., P.-J. de K., Y.M.P., W.H. van G.), University Hospital Groningen, the Netherlands; Department of Cardiology (A.A.V., J.H.K.), St Antonius Hospital Nieuwegein, the Netherlands; and Department of Cardiology (H.S.), University Hospital Regensburg, Germany.
Correspondence to Margreeth Oosterga, MD, Department of Clinical Pharmacology, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, Netherlands.
Background Left ventricular dilation after acute myocardial infarction (MI) is mainly determined by infarct size. In addition, this detrimental structural adaptation seems to be augmented in patients with the ACE DD genotype. The ACE DD genotype is associated with increased ACE activity. The aim of the present study was to evaluate whether ACE activity per se may carry prognostic significance for subsequent left ventricular dilation as assessed by echocardiography during 1-year follow-up after acute MI.
Methods and Results Left ventricular
end-systolic and end-diastolic volume indexes were
assessed by two-dimensional echocardiography. In
102 consecutive patients, plasma ACE activity was determined 3.7±0.1
hours after the onset of MI. In 64 of these patients, left
ventricular volume indexes obtained at baseline and 1 year
after MI were used for the present analysis. Patients were
divided into a group having low ACE activity (
12 IU/L, n=15) and a
group having high ACE activity (>12 IU/L, n=49). Infarct size was a
significant predictor of the increase in left ventricular
volume indexes (P=.0001) in these patients.
Multivariate regression analysis, after
correction for infarct size, demonstrated that elevated plasma ACE
activity is a significant predictor of the increase in left
ventricular end-diastolic and
end-systolic volume indexes (P=.0006 and
P=.02, respectively) 1 year after MI.
Conclusions Elevated plasma ACE activity determined soon after the onset of MI may be a significant predictor of the development of left ventricular dilation and may identify patients at risk.
Key Words: myocardial infarction • angiotensin • enzymes • remodeling • genes
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