EFFECTS OF LONG-TERM ENALAPRIL THERAPY ON CARDIAC STRUCTURE AND FUNCTION IN PATIENTS WITH LEFT-VENTRICULAR DYSFUNCTION - RESULTS OF THE SOLVD ECHOCARDIOGRAPHY SUBSTUDY
B. Greenberg et al., EFFECTS OF LONG-TERM ENALAPRIL THERAPY ON CARDIAC STRUCTURE AND FUNCTION IN PATIENTS WITH LEFT-VENTRICULAR DYSFUNCTION - RESULTS OF THE SOLVD ECHOCARDIOGRAPHY SUBSTUDY, Circulation, 91(10), 1995, pp. 2573-2581
Background Studies of Left Ventricular Dysfunction (SOLVD) demonstrate
d that enalapril therapy significantly improved the clinical course of
patients with left ventricular (LV) dysfunction. The goals of this su
bstudy were to evaluate changes in LV structure and function in SOLVD
patients and to test the hypothesis that enalapril inhibits remodeling
in patients with LV dysfunction. Methods and Results Patients enterin
g both the prevention and treatment arms of SOLVD from 5 of the 23 cli
nical centers were recruited for this substudy. The 301 patients who p
articipated underwent Doppler-echocardiographic evaluation according t
o standard protocol before randomization to either enalapril or placeb
o and again after 4 and 12 months of therapy. Recorded data were analy
zed in a blinded fashion at a central core laboratory. Analysis of bas
eline clinical characteristics showed that patients enrolled in the su
bstudy were generally representative of the SOLVD population, although
prevention arm patients were slightly overrepresented in the substudy
group (69.8% compared with 61.9% of remaining SOLVD patients). The en
alapril group demonstrated significant reductions in the mitral annula
r E-wave-to-A-wave velocity ratio (due predominantly to a reduction in
E-wave velocity), and this response was different from that seen in t
he placebo group (P=.030). Changes in the E-to-A ratio in the enalapri
l group correlated significantly with changes in plasma atrial natriur
etic peptide (r=.56; P less than or equal to.01). LV end-diastolic and
end-systolic volumes increased in placebo but not enalapril-treated p
atients, and the differences in response between the treatment groups
were significant (P=.025 and .019, respectively). LV mass tended to in
crease in placebo patients and to be reduced in enalapril-treated pati
ents, and the difference in response between the groups was highly sig
nificant (P less than or equal to.001). Conclusions These data demonst
rate that enalapril attenuates progressive increases in LV dilatation
and hypertrophy in patients with LV dysfunction. The results support t
he possibility that the favorable effects of enalapril reported in the
SOLVD trials were related to inhibition of LV remodeling.