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Preventive treatment of asymptomatic left ventricular dysfunction following myocardial infarction
1Department of Medicine, University of Auckland School of Medicine, New Zealand.
Insights
Captopril significantly improved left ventricular function and prevented clinical heart failure after myocardial infarction. Frusemide also reduced heart failure but did not prevent ventricular dilatation, unlike captopril.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Progressive asymptomatic ventricular dilatation can follow myocardial infarction, leading to severe ventricular dysfunction and congestive heart failure.
- Early identification and intervention for left ventricular dysfunction post-myocardial infarction are crucial.
Purpose of the Study:
- To evaluate the effects of captopril and frusemide on asymptomatic left ventricular dysfunction following myocardial infarction.
- To compare the efficacy of captopril and frusemide against placebo in preventing ventricular dilatation and clinical heart failure.
Main Methods:
- A randomized, double-blind trial involving 90 patients with asymptomatic left ventricular dysfunction (ejection fraction < 45%) one week post-Q wave myocardial infarction.
- Assessment of left ventricular volumes and function using two-dimensional echocardiography over a one-year follow-up period.
- Comparison of captopril (25 mg tid), frusemide (40 mg daily), and placebo treatment groups.
Main Results:
- Captopril significantly reduced left ventricular end-systolic volume index and increased stroke volume index and ejection fraction.
- Frusemide and placebo groups showed increased ventricular volumes and reduced ejection fraction.
- Captopril demonstrated a significant improvement in ejection fraction change compared to frusemide and placebo (P < 0.0001).
- Clinical heart failure occurred significantly less in the captopril and frusemide groups compared to placebo (P < 0.05).
- Captopril maintained blood pressure within the normal range, unlike frusemide and placebo.
Conclusions:
- Captopril effectively improves asymptomatic left ventricular dysfunction and prevents clinical heart failure in the year following myocardial infarction.
- Frusemide may help prevent clinical heart failure but does not halt progressive ventricular dilatation.
- Early intervention with captopril is beneficial for managing post-myocardial infarction left ventricular remodeling and dysfunction.
Abstract:
Progressive asymptomatic ventricular dilatation can occur following myocardial infarction and severe ventricular dysfunction is often present by the time clinical congestive heart failure occurs. In a randomized, double-blind trial, the effects of captopril 25 mg tid, frusemide 40 mg daily and placebo were studied in 90 patients with asymptomatic left ventricular dysfunction (ejection fraction less than 45%) 1 week following Q wave myocardial infarction. Left ventricular volumes and function were assessed at intervals during the subsequent year using two-dimensional echocardiography. The frusemide and placebo groups showed significant increases in ventricular volumes with stroke volume index unchanged and ejection fraction slightly reduced, whereas the captopril group showed a significant reduction in left ventricular end-systolic volume index with stroke volume index and ejection fraction increased. At 12 months the difference in the change in ejection fraction from baseline between the captopril and frusemide groups was 10.5% and captopril and placebo groups 9.6% (both P less than 0.0001). There was a significant difference in occurrence of clinical heart failure in the placebo group compared with the other groups (P less than 0.05). Blood pressure increased significantly within the normal range in the placebo and frusemide groups whereas there was essentially no change from baseline in the captopril group. There was no significant correlation between baseline left ventricular volumes and function and subsequent change, and anterior and inferior infarct subgroups showed similar responses within the treatment groups. In conclusion, captopril improves asymptomatic ventricular dysfunction and prevents clinical heart failure during the year following myocardial infarction. Frusemide may also prevent clinical heart failure but not progressive ventricular dilatation.
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