LONG-TERM EFFECTS ON CARDIAC-OUTPUT AND PERIPHERAL RESISTANCE IN PATIENTS TREATED WITH ENALAPRIL AFTER ACUTE MYOCARDIAL-INFARCTION

In the Cooperative New Scandinavian Enalapril Survival Study (CONSENSU S II), in which enalapril treatment was initiated intravenously within 24 h after acute myocardial infarction, there was a neutral effect on 6-month mortality, whereas a beneficial effect on the progression of congestive heart failure was noted. We studied the effect of enalapril on left ventricular systolic function in terms of cardiac output and mean acceleration time measured by pulsed-wave Doppler in the left ven tricular outflow tract and peripheral resistance. Early angiotensin-co nverting enzyme inhibition after acute myocardial infarction did not r esult in a general improvement of cardiac output. However, a small inc rease in cardiac output was observed in a subgroup of enalapril-treate d patients with ejection fraction greater than or equal to 45%, probab ly due to a reduction in peripheral resistance in these patients.