title: Angiotensin-converting enzyme inhibitor therapy affects left ventricular mass in patients with ejection fraction > 40% after acute myocardial infarction.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Medicine, Birmingham Veteran Affairs Medical Center, Alabama.
authors.forename: D B
authors.initials: DB
authors.lastname: Johnson
authors.forename: R E
authors.initials: RE
authors.lastname: Foster
authors.forename: F
authors.initials: F
authors.lastname: Barilla
authors.forename: G G
authors.initials: GG
authors.lastname: Blackwell
authors.forename: M
authors.initials: M
authors.lastname: Roney
authors.forename: A W
authors.initials: AW
authors.lastname: Stanley
authors.forename: K
authors.initials: K
authors.lastname: Kirk
authors.forename: R A
authors.initials: RA
authors.lastname: Orr
authors.forename: R J
authors.initials: RJ
authors.lastname: van der Geest
authors.forename: J H
authors.initials: JH
authors.lastname: Reiber
authors.forename: L J
authors.initials: LJ
authors.lastname: Dell'Italia
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000188:drug therapy* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D017257:Ramipril / Q000627:therapeutic use*; D013318:Stroke Volume / Q000187:drug effects; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D017257:Ramipril