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Angiotensin-converting enzyme inhibitor therapy affects left ventricular mass in patients with ejection fraction >
D B Johnson1, R E Foster, F Barilla
1Department of Medicine, Birmingham Veteran Affairs Medical Center, Alabama.
Insights
Angiotensin-converting enzyme (ACE) inhibitor therapy, specifically ramipril, reduced left ventricular (LV) mass in patients post-myocardial infarction (MI) with preserved ejection fraction. This LV mass reduction occurred without significant changes in blood pressure or LV function after 3 months.
Area of Science:
- Cardiology
- Pharmacology
- Cardiovascular Imaging
Background:
- Angiotensin-converting enzyme (ACE) inhibitor therapy demonstrates an early mortality benefit in acute myocardial infarction (MI) patients, even those without heart failure.
- The impact of ACE inhibitors on left ventricular (LV) mass and volume in post-MI patients with preserved ejection fraction remains understudied.
Purpose of the Study:
- To investigate the effect of ACE inhibitor therapy on left ventricular (LV) mass in patients with a left ventricular ejection fraction (LVEF) greater than 40% after their first acute Q wave myocardial infarction (MI).
Main Methods:
- A randomized controlled trial involving 35 patients with LVEF > 40% post-MI.
- Patients received either titrated oral ramipril (n=20) or conventional therapy (control, n=15).
- Magnetic resonance imaging (MRI) was used to assess LV volumes and mass at an average of 7 days and 3 months post-MI.
Main Results:
- Ramipril treatment led to a significant decrease in LV mass index (82 +/- 18 to 73 +/- 19 g/m2, p = 0.0002) over 3 months.
- No significant changes in LV end-diastolic volume index or stroke volume index were observed in the ramipril group compared to controls.
- Systolic arterial pressure and LV function remained unchanged in both groups at 3-month follow-up.
Conclusions:
- Ramipril therapy effectively decreased left ventricular (LV) mass in patients with preserved ejection fraction following acute myocardial infarction (MI).
- The observed reduction in LV mass occurred independently of changes in blood pressure or LV function.
- Further research is warranted to determine if this sustained decrease in LV mass is associated with reduced adverse cardiovascular events.
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/m2) or in control patients (62 +/- 16 to 68 +/- 17 ml/m2), and stroke volume index increased significantly in both groups. However, LV mass index decreased in ramipril-treated patients (82 +/- 18 to 73 +/- 19 g/m2, p = 0.0002) but not in the control patients (77 +/- 15 to 79 +/- 23 g/m2). 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.