EFFECT OF ENALAPRIL INITIATED EARLY AFTER ACUTE MYOCARDIAL-INFARCTIONON HEART-FAILURE PARAMETERS, WITH REFERENCE TO CLINICAL CLASS AND ECHOCARDIOGRAPHIC DETERMINANTS

Background and hypothesis: Although the angiotensin-converting enzyme inhibitor enalapril has recently been shown to reduce mortality and th e need for hospitalization in patients with left ventricular dysfuncti on and congestive heart failure, this drug was found to have no signif icant impact on short-term mortality after acute myocardial infarction (AMI) in the CONSENSUS II trial. The effect of enalapril initiated ea rly after AMI on clinical and echocardiographic determinants of left v entricular (LV) function was studied in a subset of patients from CONS ENSUS II. Methods: Symptoms and signs of heart failure were classified as NYHA and dyspnea classes. Echocardiography included LV end-systoli c volumes (ESV) and end-diastolic volumes (EDV), as well as ejection f raction (EF), wall motion index (WMI), and mitral flow indices. In all , 428 patients were included and followed for an average of 5.1 months by serial examinations, starting 2-5 days after myocardial infarction (MI) and repeated after 1 month and at the completion of the study. R esults: There was no beneficial effect of enalapril on clinically dete rmined function. Changes (i.e., changes in NYHA class) in the function al status remained correlated with changes in echocardiographic determ inants throughout the study in patients belonging to the placebo group : EDV index (r = 0.36, p = 0.002, ESV index (r = 0.49, p < 0.001): EF (r = -0.41, p < 0.001), and WMI (r = 0.29, p = 0.008). In a stepwise l ogistic regression model, the best baseline parameters to predict NYHA class at final visit in all patients were age (p = 0.014) and ESV ind ex (p = 0.001). Conclusion: Enalapril treatment for an average period of 5.1 months following MI resulted in no clinically significant benef icial effects on NYHA and dyspnea class. Changes in clinical function class were correlated with changes in echocardiographic determinants i n placebo-treated patients, but not in patients given enalapril.