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Left ventricular dilatation following myocardial infarction: clinical course and potential for therapy

G A Lamas1

  • 1Harvard Medical School, Brigham and Women's Hospital, Boston, Mass 02115.

Cardiology
|January 1, 1989
PubMed

Insights

Cardiac enlargement after myocardial infarction (MI) is linked to reduced survival. Angiotensin-converting enzyme (ACE) inhibition with captopril may halt this progressive left ventricular enlargement, with ongoing trials assessing its impact on survival.

Area of Science:

  • Cardiology
  • Heart Failure Research
  • Clinical Trials

Background:

  • Cardiac enlargement is a known indicator of systolic dysfunction and reduced survival.
  • Progressive left ventricular (LV) enlargement occurs after acute myocardial infarction (AMI).
  • This enlargement involves infarct expansion, regional lengthening, and overall LV volume increase over time.

Purpose of the Study:

  • To investigate the progressive nature of cardiac enlargement following acute myocardial infarction (AMI).
  • To evaluate the potential of angiotensin-converting enzyme (ACE) inhibition to halt post-infarction LV enlargement.
  • To inform the ongoing Survival and Ventricular Enlargement (SAVE) trial on captopril's efficacy.

Main Methods:

  • Review of experimental and clinical studies on cardiac enlargement post-AMI.
  • Analysis of the temporal progression of LV volume changes after infarction.
  • Consideration of pharmacological interventions, specifically ACE inhibition with captopril.

Main Results:

  • Cardiac enlargement post-AMI is a multi-stage process occurring over days, weeks, and up to a year.
  • Experimental and clinical data suggest ACE inhibition can mitigate progressive LV enlargement.
  • The SAVE trial is investigating if captopril improves survival after infarction.

Conclusions:

  • Progressive left ventricular enlargement after AMI is a significant factor impacting survival.
  • Angiotensin-converting enzyme inhibition, exemplified by captopril, shows promise in preventing detrimental cardiac remodeling.
  • Further clinical validation through trials like SAVE is crucial to confirm survival benefits.

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