Effect of early enalapril therapy on left ventricular function and structure in acute myocardial infarction

Steven P Schulman, James L Weiss, Lewis Becker, Alan D. Guerci, Edward Shapiro, Nisha Chandra, Cynthia Siu, John T. Flaherty, Vicki Coombs, Jean C. Taube, Raymond Bahr, Elliot R. McVeigh, Harlan F. Weisman, Myron Weisfeldt, Gary Gerstenblith

Research output: Contribution to journalArticle

Abstract

Infarct expansion starts within hours to days after transmural myocardial injury. Previous echocardiographic and left ventriculographic studies demonstrated that angiotensin-converting enzyme (ACE) inhibitor therapy limits left ventricular dilatation, particularly in patients with anterior wall acute myocardial infarction (AMI) or impaired left ventricular function. Forty-three patients with an acute Q-wave AMI were randomized within 24 hours of symptom onset to intravenous enalaprilat (1 mg) or placebo. Patients were then given corresponding oral therapy and followed for 1 month. Predrug and 1-month gated blood pool scans were obtained in 32 patients to evaluate changes in cardiac volumes and ejection fraction. Twenty-three patients underwent magnetic resonance imaging at 1 month to evaluate left ventricular infarct expansion. Blood pressure decreased at 6 hours but returned to baseline in both groups after 1 month of therapy. The change in cardiac volumes from baseline to 1 month differed between the placebo (end-diastolic volume +16 ± 5 ml, end-systolic volume +8 ± 6 ml), and enalapril (end-diastolic volume -8 ± 9 ml and end-systolic volume -14 ± 7 ml) groups (p <0.05 vs placebo). Global and infarct zone ejection fractions improved significantly at 1 month in the enalapril group (+6 ± 3% and 19 ± 5%, respectively) but did not change over 1 month in the placebo group. Infarct segment length and infarct expansion index by magnetic resonance imaging were significantly less in those treated with enalapril, suggesting less infarct expansion in this group. Thus, early administration of enalaprilat to patients presenting with a first Q-wave AMI prevents cardiac dilatation and infarct expansion.

Original languageEnglish (US)
Pages (from-to)764-770
Number of pages7
JournalThe American Journal of Cardiology
Volume76
Issue number11
DOIs
StatePublished - Oct 15 1995

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Enalapril
Secondary Prevention
Left Ventricular Function
Myocardial Infarction
Placebos
Enalaprilat
Cardiac Volume
Dilatation
Magnetic Resonance Imaging
Anterior Wall Myocardial Infarction
Enzyme Therapy
Angiotensin-Converting Enzyme Inhibitors
Blood Pressure
Wounds and Injuries
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of early enalapril therapy on left ventricular function and structure in acute myocardial infarction. / Schulman, Steven P; Weiss, James L; Becker, Lewis; Guerci, Alan D.; Shapiro, Edward; Chandra, Nisha; Siu, Cynthia; Flaherty, John T.; Coombs, Vicki; Taube, Jean C.; Bahr, Raymond; McVeigh, Elliot R.; Weisman, Harlan F.; Weisfeldt, Myron; Gerstenblith, Gary.

In: The American Journal of Cardiology, Vol. 76, No. 11, 15.10.1995, p. 764-770.

Research output: Contribution to journalArticle

Schulman, Steven P ; Weiss, James L ; Becker, Lewis ; Guerci, Alan D. ; Shapiro, Edward ; Chandra, Nisha ; Siu, Cynthia ; Flaherty, John T. ; Coombs, Vicki ; Taube, Jean C. ; Bahr, Raymond ; McVeigh, Elliot R. ; Weisman, Harlan F. ; Weisfeldt, Myron ; Gerstenblith, Gary. / Effect of early enalapril therapy on left ventricular function and structure in acute myocardial infarction. In: The American Journal of Cardiology. 1995 ; Vol. 76, No. 11. pp. 764-770.
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AU - Siu, Cynthia

AU - Flaherty, John T.

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AU - Bahr, Raymond

AU - McVeigh, Elliot R.

AU - Weisman, Harlan F.

AU - Weisfeldt, Myron

AU - Gerstenblith, Gary

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N2 - Infarct expansion starts within hours to days after transmural myocardial injury. Previous echocardiographic and left ventriculographic studies demonstrated that angiotensin-converting enzyme (ACE) inhibitor therapy limits left ventricular dilatation, particularly in patients with anterior wall acute myocardial infarction (AMI) or impaired left ventricular function. Forty-three patients with an acute Q-wave AMI were randomized within 24 hours of symptom onset to intravenous enalaprilat (1 mg) or placebo. Patients were then given corresponding oral therapy and followed for 1 month. Predrug and 1-month gated blood pool scans were obtained in 32 patients to evaluate changes in cardiac volumes and ejection fraction. Twenty-three patients underwent magnetic resonance imaging at 1 month to evaluate left ventricular infarct expansion. Blood pressure decreased at 6 hours but returned to baseline in both groups after 1 month of therapy. The change in cardiac volumes from baseline to 1 month differed between the placebo (end-diastolic volume +16 ± 5 ml, end-systolic volume +8 ± 6 ml), and enalapril (end-diastolic volume -8 ± 9 ml and end-systolic volume -14 ± 7 ml) groups (p <0.05 vs placebo). Global and infarct zone ejection fractions improved significantly at 1 month in the enalapril group (+6 ± 3% and 19 ± 5%, respectively) but did not change over 1 month in the placebo group. Infarct segment length and infarct expansion index by magnetic resonance imaging were significantly less in those treated with enalapril, suggesting less infarct expansion in this group. Thus, early administration of enalaprilat to patients presenting with a first Q-wave AMI prevents cardiac dilatation and infarct expansion.

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