The effects of early captopril treatment on left ventricular volumes and function in patients with and without depressed global ejection fraction after acute myocardial infarction

To determine the effects of captopril on left ventricular volumesand function in patients with and without depressed ventricularfunction following acute myocardial infarction (AMI) we studied78 patients with a first Q wave AMI and no clinical evidenceof heart failure. All patients underwent radionuclide ventriculography(RVG) on the 4th day after admission and were then randomlyassigned to receive conventional treatment alone (36 patients,control group) or with the addition of oral captopril, 25 mgthree times daily (42 patients, captopril group). RVG was repeatedone month after the baseline examination. After one month theleft ventricular ejection fraction (LVEF) significantly increasedin the captopril group (from 43.2±1.3 to 50.9±1.6%,P<0.001) and remained relatively unchanged in the controlgroup (from 47±1.3 to 49.2±1.7%, P=ns). In thecaptopril group the subgroup of patients with a baseline LVEF<45% demonstrated a significant decrease in end-systolicvolume index (ESVI) (from 53.3 ±3.2 to 42.4±2.8ml.m^–2,P<0.002) and a highly significant improvement in LVEF (from36.3±1.3 to 49.6±1.8%, P<0.00005). In the controlgroup, LVEF also increased in those in whom it was <45% (from38±1.4 to 42±2.4%, P<0.01), but the increasewas less than that in the captopril group (P<0.01), mainlydue to an increase in end-diastolic volume index (EDVI) (from78.2±4.6 to 84.6±12.3 ml.m^–2, P=ns). Inboth the captopril and control subgroups of patients with abaseline LVEF 45% there was no significant change in LVEF (from50.1±0.8 to 52.1±2.6% and 53.4±1.5 to 54.2±2.1%respectively), but there was a trend for both left ventricularvolumes to increase (EDVI: from 81.4±4.7 to 91.1±9.9ml.m^–2and 76±5.7 to 90.3±9.2 ml.m^–2; ESVI: from40.6±2.6 to 45.2 ±3.4 ml.m^–2 and 32.1±2.6to 40.1 ±3.8 ml.m^–2 respectively, all P=ns). In conclusion, our study confirmed the beneficial effect ofcaptopril on left ventricular size and function in patientswith depressed global LVEF after AMI, but there was no evidenceof a similar effect in patients with preserved global LVEF,at least during the first month of treatment.