EFFECTS OF LONG-TERM ENALAPRIL THERAPY ON CARDIAC STRUCTURE AND FUNCTION IN PATIENTS WITH LEFT-VENTRICULAR DYSFUNCTION - RESULTS OF THE SOLVD ECHOCARDIOGRAPHY SUBSTUDY

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.