Effect of angiotensin-converting enzyme inhibition on functional class in patients with left ventricular systolic dysfunction--a meta-analysis.
BACKGROUND
The effect of angiotensin converting enzyme (ACE) inhibitors on symptoms in patients with left ventricular systolic dysfunction (LVSD) is controversial.


OBJECTIVE
To perform a meta-analysis of studies evaluating effect of ACE inhibitors on New York Heart Association (NYHA) class in patients with LVSD.


METHODS
Individual data from 10389 patients in NYHA classes I-IV from four large long-term studies (2-4-year follow-up) and summary data from 2302 patients in NYHA classes II-IV from 16 short-term studies (3 months follow-up) were meta-analysed to assess changes in NYHA class.


RESULTS
The large long-term studies showed a significant improvement in the worst NYHA classes (classes II-IV compared to class I) in the ACE inhibitor arm versus placebo, odds ratio (OR) = 0.875 (0.811-0.943) p = 0.0005. This effect was only present in studies which included patients with chronic heart failure and was particularly pronounced on deterioration to the worst NYHA class IV, OR = 0.66 (0.52-0.84) p = 0.001. There was no effect in the studies which included patients after myocardial infarction. The short-term chronic heart failure studies showed a significant improvement in NYHA class; OR for improvement of at least one NYHA class was 2.11 (1.48-2.98, 95% CI) p < 0.0001.


CONCLUSIONS
ACE inhibition significantly improves symptomatic status measured as NYHA classification in patients with chronic heart failure.
Abdulla
Jawdat
J
Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark. ja@heart.dk
Pogue
Janice
J
Abildstrøm
Steen Z
SZ
Køber
Lars
L
Christensen
Erik
E
Pfeffer
Marc A
MA
Yusuf
Salim
S
Torp-Pedersen
Christian
C
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D009200:Myocardial Contraction / Q000187:drug effects* / Q000502:physiology; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology
D000806:Angiotensin-Converting Enzyme Inhibitors