EFFECT OF ANGIOTENSIN-CONVERTING ENZYME-I NHIBITORS AND GLYCOSIDES ONLEFT-VENTRICULAR REMODELING

Effects of enalapril and digoxin on left ventricular remodeling were e valuated in a randomized placebo-controlled study on 68 patients with chronic NYHA class II -- III heart failure due to dilated cardiomyopat hy (n=33) and ischemic heart disease (n=35). All patients were in sinu s rhythm. Patients were randomized for enalapril (group 1), digoxin (g roup 2), or placebo (group 3). Duration of study was 3 months. Spirove loergometry and cine magnetic resonance tomography were performed prio r to and in the end of treatment. Dynamics of parameters of patient's functional state in enalapril treated patients differed from that in p atients receiving digoxin and placebo. In group I anaerobic threshold and functional class improved by 6,1 and 10,7%, respectively (p<0,01) while in other 2 groups the changes were either insignificant or negat ive. Similar tendency was noted in results of magnetic resonance tomog raphy. In enalapril group left ventricular volumes decreased while in groups 2 and 3 increased. Ejection fraction rose in the enalapril grou p, remained practically unchanged in digoxin treated patients, and dec reased on placebo. Significant lowering of myocardial stress (by 30,9% ) and increase of relative wall thickness index (by 14,4%) occurred so lely in the enalapril group while in other groups these parameters wor sened. Thus comparison of results of 3- month treatment of patients wi th chronic heart failure and sinus rhythm by enalapril, digoxin, or pl acebo clearly indicated superiority of the angiotensin converting enzy me inhibitor.