Left ventricular dilatation after myocardial infarction: ACE inhibitors, beta-blockers, or both?
Left ventricular (LV) dilatation after myocardial infarction (MI) is a major predictor of prognosis and identifies which patients will develop heart failure. Left ventricular dilatation or remodeling starts immediately after MI and progresses in the chronic phase of heart failure. Factors influencing remodeling, such as infarct size and neurohumoral activation, including the sympathetic and renin-angiotensin system, are discussed. Remodeling can be affected by reduction of infarct size and inhibition of neurohumoral activation. The effect of thrombolysis, beta-blockade, and angiotensin-converting enzyme (ACE) inhibition in the acute phase after MI and in the chronic phase of heart failure on remodeling are discussed. On the basis of beneficial effects of ACE inhibition and beta-blockade in acute MI and in chronic heart failure, a treatment strategy is proposed in which both ACE inhibition and beta-blockade are started early after MI. Depending on infarct size and ventricular function, continued treatment in the chronic phase of heart failure must be considered.
Anthonio
R L
RL
Institute of Clinical Pharmacology, University of Groningen, and Department of Cardiology/Thorax Center, University Hospital Groningen, The Netherlands.
van Veldhuisen
D J
DJ
van Gilst
W H
WH
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D004108:Dilatation, Pathologic / Q000188:drug therapy / Q000209:etiology; D006333:Heart Failure; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy*; D018377:Neurotransmitter Agents / Q000502:physiology; D016277:Ventricular Function, Left / Q000187:drug effects; D020257:Ventricular Remodeling / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D018377:Neurotransmitter Agents