Abstract
Background: Clinical signs of heart failure such as pulmonary rales and dyspnea, ventricular dysfunction, and ventricular arrhythmia are independent predictors of a poor prognosis after acute myocardial infarction (AMI).
Hypothesis: The study aimed to assess the effect of ramipril treatment on mildly depressed left ventricular (LV) systolic function, assessed by atrioventricular (AV) plane displacement in patients with congestive heart failure after AMI.
Methods:The study was a substudy in the Acute Infarction Ramipril Efficacy Study, a double‐blind, randomized, placebo‐controlled trial of ramipril versus placebo in patients with symptoms of heart failure after AMI. In all, 56 patients were included in the main study, 4 refused to participate in the substudy, and 4 were excluded for logistical reasons. Echocardiography was performed at entry and after 6 months. Patients who underwent coronary artery bypass grafting during the follow‐up period were excluded.
Results: At baseline, the patients had modest LV dysfunction, and mean AV plane displacement of 9.7 mm. During follow‐up, AV plane displacement increased in ramipril‐treated patients from 9.5 to 10.9 mm (p < 0.01). No statistically significant changes were seen in the placebo group.
Conclusions: Ramipril improves LV systolic function in patients with clinical signs of heart failure and only modest systolic dysfunction after AMI. Measurement of AV plane displacement is a simple and reproducible method for detection of small changes in systolic function and may be used instead of ejection fraction in patients with poor image quality.
Keywords: myocardial infarction, heart failure, left ventricular systolic function, ramipril
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References
- 1. The Multicenter Post Infarction Research Group : Risk stratification and survival after acute myocardiul infarction. N Engl J Med 1983; 309: 331–336 [DOI] [PubMed] [Google Scholar]
- 2. Stevenson R, Ranjadayalan K. Wilkinson P, Roberts R, Timmis AD: Short and long term prognosis of acute myocardial infarction since introduction of thrombolysis. Br Med J 1993; 307: 349–353 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Sharpe N Murphy J, Smith H Hannan S : Treatment of patients with symptomless left ventricular dysfunction after myocardial infarction. Lancet 1988; 334: 255–259 [DOI] [PubMed] [Google Scholar]
- 4. Pfeffer MA, Braunwald E: Ventricular remodel ling after myocardial infarction. Circulation 1990; 81: 1161–1172 [DOI] [PubMed] [Google Scholar]
- 5. The CONSENSUS Trial Study Group : Effects of enalapril on mortality in severe congestive heart failure: Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 1987; 316: 1429–1435 [DOI] [PubMed] [Google Scholar]
- 6. The SOLVD Investigators : Effect of enalapril on survival in patients with reduced ejection fractions and congestive heart failure. N Engl J Med 1991; 325: 293–302 [DOI] [PubMed] [Google Scholar]
- 7. The SOLVD Investigators : Effect of enalapril on mortality and development of heart failure in asymptomatic patients with reduced ejection fractions. N Engl J Med 1992; 327: 685–691 [DOI] [PubMed] [Google Scholar]
- 8. Pfeffer MA, Braunwald E, Moye LA, Basta L, Brown EJ, Cuddy TE, Davis BR, Geltman EM, Goldman S, Flaker GC, Klein M, Lamas GA. Packer M, Rouleau JL. Rutherford J. Wertheirner JH. Hawkins CM, on behalf of the SAVE Investigators : Effect of captopril on mortality and morbidity in patients with ventricular dysfunction after myocardial infarction. N Engl J Med 1992; 327: 669–677 [DOI] [PubMed] [Google Scholar]
- 9. The Acute Infarction Ramipril Efficacy (AIRE) Study investigators : Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993; 342: 821–828 [PubMed] [Google Scholar]
- 10. Hoglund C, Alain M. Thorstrand C: Atrioventricular valve plane displacement in healthy persons. Acta Med Scand 1988; 224: 557–562 [DOI] [PubMed] [Google Scholar]
- 11. Swedberg K, Held P, Kjekshus J, Rasmussen K, Rydén L, Wedel H, on behalf of the CONSENSUS II Study Group : Effects of early administration of enalapril on mortality in patients with acute myocardial infarction. Results of the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II). N Engl J Med 1992; 327: 678–684 [DOI] [PubMed] [Google Scholar]
- 12. Gøtzsche CO, Søgaard P, Ravkilde J, Thygesen K: Effects of captopril on left ventricular systolic and diastolic function after acute myocardial infarction. Am J Cunliol 1992; 79: 156–160 [DOI] [PubMed] [Google Scholar]
- 13. Sutton MSJ. Pfeffer MA, Plappert T, Rouleau JL, Moyé LA, Dagnais GR, Lamas GA, Klein M, Sussex B, Goldman S, Menapace FJ. Parker JO, Lewis S, Sestier F, Fordon DF, McEwan P, Bernstein V, Braunwald E, for the SAVE Investigators : Quantitative two‐dimensional echocardiographic measurements are major predictors of adverse cardiovascular events after acute myocardial infarction. The protective effects of captopril. Circulation 1994; 89: 68–75 [DOI] [PubMed] [Google Scholar]
- 14. Konstam MA, Rousseau MF, Kronenberg MW, Udelson JE, Melin J. Stevart D, Dolan N. Edens TR, Ahn S, Kinan D, Howe DM, Kilcoyne L, Metherall J, Benedict C, Yusuf S, Pouleur H, for the SOLVD Investigators : Effects of the angiotensin‐converting enzyme inhibitor enalapril on the long‐term progression of left ventricular dysfunction in patients with heart failure. Circulation 1992; 86: 431–438 [DOI] [PubMed] [Google Scholar]
- 15. Konstam MA, Kronenberg MW, Rousseau MF, Udelson JE, Melin J, Stewart D, Dolan N, Edens TR, Ahn S, Kinan D, Howe DM, Kilcoyne L, Metherall J, Benedict C, Yusuf S Pouleur H for the SOLVD Investigators : Effects of the angiotensin converting enzyme inhibitor enalapril on the long‐term progression of left ventricular dilatation in patients with asymptomatic systolic dysfunction. Circulation 1993; 88 (part 1): 2277–2283 [DOI] [PubMed] [Google Scholar]
- 16. Alain M. Rosenhamer G: Atrioventricular plane displacement and left ventricular function. J Am Soc Echocardiogr 1992; 4: 427–433 [DOI] [PubMed] [Google Scholar]
- 17. Alain M: The atrioventricular plane displacement as a means of evaluating left ventricular systolic function in acute myocardial infarction. Clin Cardiol 1991; 14: 588–594 [DOI] [PubMed] [Google Scholar]
- 18. Pai RG, Bodenheimer MM. Pai SM, Koss JH, Adamick RD: Usefulness of systolic excursion of mitral annulus as an index of left ventricular systolic function. Am J Cardiol 1991; 67: 222–224 [DOI] [PubMed] [Google Scholar]
- 19. Himelman RB, Cassidy MM, Landzberg JS, Shiller NB: Reproducibility of quantitative two‐dimensional echocardiography. Am Heart J 1988; 115: 425–431 [DOI] [PubMed] [Google Scholar]