EXPERIENCES WITH ACE-INHIBITORS EARLY AFTER ACUTE MYOCARDIAL-INFARCTION - RATIONALE AND DESIGN OF THE GERMAN-MULTICENTER-STUDY ON THE EFFECTS OF CAPTOPRIL ON CARDIOPULMONARY EXERCISE PARAMETERS POST MYOCARDIAL-INFARCTION (ECCE)

Left ventricular damage by necrosis of myocardial tissue can lead to c ompromise of left ventricular function, to left ventricular volume inc rease and ultimately to development of heart failure. This sequence in the pathophysiology has been shown to be blunted by ace inhibitors. V olume increase, however, can also be helpful in restoring stroke volum e and ameliorate elevation of filling pressures. Furthermore, very ear ly institution of ACE inhibition has failed to improve short-term mort ality after myocardial infarction in one large trial. The aim of ECCE trial therefore is, to investigate the early effects of the ACE inhibi tor captopril on compromise of exercise capacity, thought to be a firs t measurable sign of developing heart failure. The ECCE trial is a ran domized, seven-center investigation, studying the effects of ACE inhib ition on oxygen uptake in a double blind, placebo controlled design in a group of 204 patients. Sample size was calculated on the basis of a pilot trial. The study design and first not unblinded data of 104 pat ients are presented. The population consists of predominantly male pat ients with mostly first myocardial infarction. They were admitted to h ospital within five hours of onset of chest pain. Enddiastolic volumes were normal, but ejection fraction was moderately compromised. ACE in hibition was started after the first day, but within 72 hours of onset of chest pain. After four and after twelve weeks, oxygen uptake was c onsiderably below expected values and one third of the patients had se vere compromise of exercise capacity. Thus the patients recruited in t he ECCE trial are at risk for developing heart failure and therefore a re ideal candidates for the study of the preventive effects of ACE inh ibitors. Final results will be available in early 1994.