title: Prospective evaluation comparing the effects of enalapril and losartan in left ventricular remodeling after acute myocardial infarction.
abstract: BACKGROUND
  Previous studies have compared angiotensin receptor blockers and angiotensin-converting enzyme inhibitors in patients with heart failure, but there are few data about the effect of these drugs regarding left ventricular remodeling after myocardial infarction.
  
  
  METHODS
  Fifty-two consecutive patients with first anterior wall myocardial infarction within 24 hours of evolution were randomized to receive enalapril (as much as 20 mg; mean, 14.6 mg), or losartan (as much as 50 mg; mean, 48 mg). Left ventricular ejection fraction and ventricular volumes were analyzed in 2 serial radionuclide ventriculograpies, carried out within 4 days after the infarction (mean, 97.4 +/- 114.2 hours) and after 6 months (mean, 177.7 +/- 16.7 days). Ventriculographies were analyzed by a single blinded observer. Mainly because of the unexpected large SD values obtained, the power of the study to demonstrate equivalence between the groups was only 15.7%.
  
  
  RESULTS
  The differences obtained between the first and the second ventriculographies, for the enalapril and losartan groups, were: for left ventricular ejection fraction, -0.4% +/- 6.6% versus -1.1% +/- 5.9% (P =. 67; 95% CI, 2.77-4.23); for final systolic volume, 0.07 +/- 7.7 mL/m(2) versus -0.2 +/- 6.1mL/m(2) (P =. 85; 95% CI, -3.57-4.26); for final diastolic volume -0.7 +/- 12.1 mL/m(2) versus -3.6 - 9.9 mL/m(2) (P =. 34; 95% CI, -3.22-9.17).
  
  
  CONCLUSIONS
  This study, although underpowered, suggests that neither enalapril nor losartan was superior as compared with each other for left ventricular remodeling after myocardial infarction; however, powerful evidence of equivalence was not provided.
authors.affiliation: Hospital de Base, São José do Rio Preto Medical School (FAMERP) and Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. ucor@famerp.br
authors.forename: Lilia Nigro
authors.initials: LN
authors.lastname: Maia
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Nicolau
authors.forename: João V
authors.initials: JV
authors.lastname: Vítola
authors.forename: Márcio
authors.initials: M
authors.lastname: Santos
authors.forename: Josélia Menin
authors.initials: JM
authors.lastname: Brandi
authors.forename: Marcos Rogério
authors.initials: MR
authors.lastname: Joaquim
authors.forename: José Mário
authors.initials: JM
authors.lastname: Baggi
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Cordeiro
authors.forename: Moacir F
authors.initials: MF
authors.lastname: de Godoy
mesh_terms: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002216:Captopril; D004656:Enalapril / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology*; D015635:Radionuclide Ventriculography / Q000379:methods; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology; D020257:Ventricular Remodeling / Q000187:drug effects* / Q000502:physiology
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004656:Enalapril; D002216:Captopril; D019808:Losartan