(Circulation. 1995;91:2573-2581.)
© 1995 American Heart Association, Inc.
Articles |
Effects of Long-term Enalapril Therapy on Cardiac Structure and Function in Patients With Left Ventricular Dysfunction
Results of the SOLVD Echocardiography Substudy
From the Division of Cardiology (B.G.), Oregon Health Sciences University, Portland, Ore; Baylor College School of Medicine (M.A.Q.), Houston, Tex; Dalhousie University School of Medicine (C.K.), Halifax, Nova Scotia, Canada; University of Florida College of Medicine (M.L.) (Gainesville); Robert Wood Johnson School of Medicine (D.S.), Piscataway, NJ; University of Texas School of Medicine (C.B.) (Galveston); and Department of Biostatistics (B.S.), Collaborating Studies Coordinating Center, Chapel Hill, NC.
Correspondence to Barry Greenberg, MD, University of California at San Diego, 200 W Arbor St, San Diego, CA 92103-8411.
Background Studies of Left Ventricular Dysfunction (SOLVD) demonstrated that enalapril therapy significantly improved the clinical course of patients with left ventricular (LV) dysfunction. The goals of this substudy were to evaluate changes in LV structure and function in SOLVD patients and to test the hypothesis that enalapril inhibits remodeling in patients with LV dysfunction.
Methods and Results Patients entering both the prevention and
treatment arms of SOLVD from 5 of the 23 clinical centers were
recruited for this substudy. The 301 patients who participated
underwent Doppler-echocardiographic evaluation according to standard
protocol before randomization to either enalapril or placebo and again
after 4 and 12 months of therapy. Recorded data were analyzed in a
blinded fashion at a central core laboratory. Analysis of baseline
clinical characteristics showed that patients enrolled in the substudy
were generally representative of the SOLVD population, although
prevention arm patients were slightly overrepresented in
the substudy group (69.8% compared with 61.9% of remaining SOLVD
patients). The enalapril group demonstrated significant reductions in
the mitral annular E-wave–to–A-wave velocity ratio (due
predominantly
to a reduction in E-wave velocity), and this response was different
from that seen in the placebo group (P=.030). Changes in the
E-to-A ratio in the enalapril group correlated significantly with
changes in plasma atrial natriuretic peptide (r=.56;
P
.01). LV end-diastolic and end-systolic
volumes increased in placebo but not enalapril-treated patients, and
the differences in response between the treatment groups were
significant (P=.025 and .019, respectively). LV mass tended
to increase in placebo patients and to be reduced in enalapril-treated
patients, and the difference in response between the groups was highly
significant (P.001).
Conclusions These data demonstrate that enalapril attenuates progressive increases in LV dilatation and hypertrophy in patients with LV dysfunction. The results support the possibility that the favorable effects of enalapril reported in the SOLVD trials were related to inhibition of LV remodeling.
Key Words: enalapril • hypertrophy • echocardiography • heart failure • atrial natriuretic peptide
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D. J. van Veldhuisen, S. Genth-Zotz, J. Brouwer, F. Boomsma, T. Netzer, A. J. Man in 't Veld, Y. M. Pinto, K. I. Lie, and H. J. G. M. Crijns High- versus low-dose ACE inhibition in chronic heart failure: A double-blind, placebo-controlled study of imidapril J. Am. Coll. Cardiol., December 1, 1998; 32(7): 1811 - 1818. [Abstract] [Full Text] [PDF]
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A. M. Katz Regression of Left Ventricular Hypertrophy : New Hope for Dying Hearts Circulation, August 18, 1998; 98(7): 623 - 624. [Full Text] [PDF]
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M. St. J. Sutton, M. A. Pfeffer, L. Moye, T. Plappert, J. L. Rouleau, G. Lamas, J. Rouleau, J. O. Parker, M. O. Arnold, B. Sussex, et al. Cardiovascular Death and Left Ventricular Remodeling Two Years After Myocardial Infarction : Baseline Predictors and Impact of Long-term Use of Captopril: Information From the Survival and Ventricular Enlargement (SAVE) Trial Circulation, November 18, 1997; 96(10): 3294 - 3299. [Abstract] [Full Text]
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R. S. Vasan, M. G. Larson, E. J. Benjamin, J. C. Evans, and D. Levy Left Ventricular Dilatation and the Risk of Congestive Heart Failure in People without Myocardial Infarction N. Engl. J. Med., May 8, 1997; 336(19): 1350 - 1355. [Abstract] [Full Text] [PDF]
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P. A. Poole-Wilson Prediction of Heart Failure -- An Art Aided by Technology N. Engl. J. Med., May 8, 1997; 336(19): 1381 - 1382. [Full Text]
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E. J. Eichhorn and M. R. Bristow Medical Therapy Can Improve the Biological Properties of the Chronically Failing Heart: A New Era in the Treatment of Heart Failure Circulation, November 1, 1996; 94(9): 2285 - 2296. [Abstract] [Full Text]
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J. N. Cohn Structural Basis for Heart Failure : Ventricular Remodeling and Its Pharmacological Inhibition Circulation, May 15, 1995; 91(10): 2504 - 2507. [Full Text]
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