title: Randomized, double-blind, placebo-controlled long-term study of isosorbide-5-mononitrate therapy in patients with left ventricular dysfunction after acute myocardial infarction.
abstract: BACKGROUND
  Nitrates are often administrated with a variety of other pharmacologic agents in the management of chronic heart failure (CHF). However, limited information is available concerning the long-term effects in patients with evidence of left ventricular (LV) dysfunction after acute myocardial infarction (AMI) already treated with standard heart failure therapy.
  
  
  METHODS
  In a randomized, double-blind, placebo-controlled trial, we evaluated the effects of a 60 mg dose of isosorbide-5-mononitrate (IS-5-MN) given daily for 11 months to 47 patients with clinical or echocardiographic evidence of left ventricular dysfunction after acute myocardial infarction. Forty-five patients received a placebo.
  
  
  RESULTS
  Invasive hemodynamic measurements did not show any difference between the treatment regimens. Overall changes in echocardiographic measurements were not significantly different between IS-5-MN therapy and the placebo groups. However, in a prespecified subgroup with left ventricular ejection fraction < or =40% at baseline, IS-5-MN therapy resulted in a lesser increase of end-diastolic volume index than the placebo (P =.047). IS-5-MN significantly reduced the serum concentration of atrial natriuretic peptide (mean 20.0 pmol/L, 95% CI 7.7-32.3, P =.002), whereas the placebo did not (P =.041 for the difference between the groups). The proportion of patients taking diuretics was significantly reduced in the IS-5-MN group, from 30 of 44 to 20 of 44 (P =.02), but not with placebo, which remained at 27 of 43 (P = 1.0, with P =.048 for the difference between the regimens).
  
  
  CONCLUSIONS
  Oral, long-term IS-5-MN therapy resulted in lower atrial natriuretic peptide levels and reduced the need for additional diuretics. Less LV dilatation was observed in patients with more severe LV dysfunction at baseline.
authors.affiliation: Department of Cardiology, University Hospital, Lund, Sweden. erik.tingberg@kard.lu.se
authors.forename: Erik
authors.initials: E
authors.lastname: Tingberg
authors.forename: Anders
authors.initials: A
authors.lastname: Roijer
authors.forename: Ulf
authors.initials: U
authors.lastname: Thilen
authors.forename: Jan
authors.initials: J
authors.lastname: Eskilsson
authors.forename: Hans
authors.initials: H
authors.lastname: Ohlin
mesh_terms: D000368:Aged; D009320:Atrial Natriuretic Factor / Q000378:metabolism; D003692:Delayed-Action Preparations; D004232:Diuretics / Q000008:administration & dosage; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007548:Isosorbide Dinitrate / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D010446:Peptide Fragments / Q000378:metabolism; D017257:Ramipril / Q000008:administration & dosage; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology
chemical_list: D003692:Delayed-Action Preparations; D004232:Diuretics; D010446:Peptide Fragments; C074733:ANF (4-28), Leu(8,18)-Ile(12)-Ala(20)-MePhe(26)-Tyr(28)-Pro(29)-; D009320:Atrial Natriuretic Factor; D007548:Isosorbide Dinitrate; D017257:Ramipril; C030397:isosorbide-5-mononitrate