Angiotensin-converting enzyme inhibitor therapy affects left ventricular mass in patients with ejection fraction >40% after acute myocardial infarction

被引:22
作者
Johnson, DB
Foster, RE
Barilla, F
Blackwell, GG
Roney, M
Stanley, AWH
Kirk, K
Orr, RA
vanderGeest, RJ
Reiber, JHC
DellItalia, LJ
机构
[1] UNIV ALABAMA, VET AFFAIRS MED CTR, DEPT MED, DIV CARDIOVASC DIS, BIRMINGHAM, AL 35294 USA
[2] UNIV ROMA LA SAPIENZA, ROME, ITALY
[3] UNIV LEIDEN HOSP, NL-2300 RC LEIDEN, NETHERLANDS
关键词
D O I
10.1016/S0735-1097(96)00451-2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives. We tested the hypothesis that angiotensin-converting enzyme (ACE) inhibitor therapy decreases left ventricular (LV) mass in patients with a left ventricular ejection fraction (LVEF) >40% and no evidence of heart failure after their first acute Q wave myocardial infarction (MI). Background. Recently, ACE inhibitor therapy has been shown to have an early mortality benefit in unselected patients with acute MI, including patients without heart failure and a LVEF >35%. However, the effects on LV mass and volume in this patient population have not been studied. Methods. Thirty five patients with a LVEF >40% after their first acute Q wave MI were randomized to titrated oral ramipril (n = 20) or conventional therapy (control, n = 15). Magnetic resonance imaging (MRI) performed an average of 7 days and 3 months after MI provided LV volumes and mass from summated serial short-axis slices. Results. Left ventricular end diastolic volume index did not change in ramipril-treated patients (62 +/- 16 [SD] to 66 +/- 17 ml/m(2)) or in control patients (62 +/- 16 to 68 +/- 17 ml/m(2)), and stroke volume index increased significantly in both groups. Pow ever, LV mass index decreased in ramipril-treated patients (82 +/- 18 to 73 +/- 19 g/m(2), p = 0.0002) but not in the control patients (77 +/- 15 to 79 +/- 23 g/m(2)). Systolic arterial pressure did not change in either group at 3-month follow-up. Conclusions. In patients with a LVEF >40% after acute MI, ramipril decreased LV mass, and blood pressure and LV function were unchanged after 3 months of therapy. Whether the decrease in mass represents a sustained effect that is associated with a decrease in morbid events requires further investigation.
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页码:49 / 54
页数:6
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