TREATMENT WITH RAMIPRIL IMPROVES SYSTOLIC FUNCTION EVEN IN PATIENTS WITH MILD SYSTOLIC DYSFUNCTION AND SYMPTOMS OF HEART-FAILURE AFTER ACUTE MYOCARDIAL-INFARCTION

Background: Clinical signs of heart failure such as pulmonary rales an d dyspnea, ventricular dysfunction, and ventricular arrhythmia are ind ependent predictors of a poor prognosis after acute myocardial infarct ion (AMI). Hypothesis: The study aimed to assess the effect of ramipri l treatment on mildly depressed left ventricular (LV) systolic functio n, assessed by atrioventricular (AV) plane displacement in patients wi th congestive heart failure after AMI. Methods: The study was a substu dy in the Acute Infarction Ramipril Efficacy Study, a double-blind, ra ndomized, placebo-controlled trial of ramipril versus placebo in patie nts with symptoms of heart failure after AMI. In all, 56 patients were included in the main study, 4 refused to participate in the substudy, and 4 were excluded for logistical reasons. Echocardiography was perf ormed at entry and after 6 months. Patients who underwent coronary art ery bypass grafting during the follow-up period were excluded. Results : At baseline, the patients had modest LV dysfunction, and mean AV pla ne displacement of 9.7 mm. During follow-up, AV plane displacement inc reased in ramipril-treated patients from 9.5 to 10.9 mm (p < 0.01). No statistically significant changes were seen in the placebo group. Con clusions: Ramipril improves LV systolic function in patients with clin ical signs of heart failure and only modest systolic dysfunction after AMI. Measurement of AV plane displacement is a simple and reproducibl e method fur detection of small changes in systolic function and may b e used instead of ejection fraction in patients with poor image qualit y.