EFFECTS OF EARLY ENALAPRIL TREATMENT ON GLOBAL AND REGIONAL WALL-MOTION IN ACUTE MYOCARDIAL-INFARCTION

Angiotensin-converting-enzyme inhibitor therapy can preserve left vent ricular (LV) function and geometric features and improve survival in s ubsets of patients with acute myocardial infarction (AMI). We investig ated the effect of enalapril treatment initiated <24 hours after AMI o n global and regional echocardiographic wall motion indexes obtained a t 2 to 5 days and at 1 and 6 months in 428 consecutive patients enroll ed in the randomized, placebo-controlled Cooperative New Scandinavian Enalapril Survival Study II, In anterior AMIs, the non-infarct-rone in dex deteriorated in the placebo group but remained unchanged in the en alapril-treated group (0.18 vs 0.02; p less than or equal to 0.05), an effect related to attenuated LV volume expansion. No treatment effect s were observed in nonanterior AMIs or in the entire unselected popula tion. Thus in an unselected population with AMI, early enalapril treat ment had no effect on LV function; yet in patients with anterior infar cts, LV function was maintained through preservation of function in th e noninfarcted myocardium.