BENEFIT OF CONVERTING-ENZYME INHIBITION ON LEFT-VENTRICULAR VOLUMES AND EJECTION FRACTION IN PATIENTS RECEIVING BETA-BLOCKADE AFTER MYOCARDIAL-INFARCTION

beta-blockers reduce infarct size and improve survival after acute myo cardial infarction (MI). post-MI angiotensin-converting enzyme inhibit ion also improves survival and may attenuate left ventricular (LV) dil atation. We evaluated the effect of early enalapril treatment on LV vo lumes and ejection fraction (EF) in patients on concomitant beta-block ade after MI. Intravenous enalaprilat or placebo was administered <24 hours after MI and was continued orally for 6 months. LV volumes were assessed by echocardiography 3 +/- 2 days, 1 and 6 months after MI. Ch ange in LV diastolic volume during the first month was attenuated with enalapril (2.7 vs placebo 6.5 ml/m(2) change; p < 0.05), and signific antly lower LV diastolic and systolic volumes were observed with enala pril treatment compared with placebo at 1 month (enalapril 47.2/23.9 v s placebo 53.1/29.2 ml/m(2); p < 0.05) and at 6 months (enalapril 47.9 /24.8 vs placebo 53.8/29.6 ml/m(2); p < 0.05). EF was also significant ly higher 1 month after MI in these patients (enalapril 50.4% vs place bo 46.4%; p < 0.05). Our data demonstrate that early enalapril treatme nt attenuates LV volume expansion and maintains lower LV volumes and h igher EF in patients receiving concurrent beta-blockade after MI. A po ssible additive effect of combined therapy should be evaluated prospec tively.