Structural and functional state of left ventricle and efficacy of an angiotensin converting enzyme perindopril in patients with heart failure after myocardial infarction: Relation to angiotensin converting enzyme gene polymorphism

Aim. To study relationship between structural and functional state of left ventricle and angiotensin converting enzyme (ACE) genotype in patients with chronic heart failure after myocardial infarction and dependence of hemody namic effects of an ACE inhibitor perindopril on ACE gene polymorphism Mate rial and methods. 52 patients with NYHA class III-IV heart failure after my ocardial infarction. ACE genotypes were determined by polymerase chain reac tion. Echocardiography was carried out before perindopril, in the end of ti tration phase, and in 6 and 12 months of therapy with perindopril. Results. II, ID and DD genotypes were found in 11 (21,1%), 20 (38,5%) and 21 (40,4% ) patients, respectively. As there was no significant difference in initial hemodynamic parameters between patients with II and ID genotypes all patie nts were divided into two groups - with genotypes II and ID (group 1) and D D (group 2). Patients of group 1 compared with those of group 2 had signifi cantly lower end systolic and diastolic volumes and left ventricular myocar dial mass index (by 45,7, 81,6 and 31,2%, respectively) and higher ejection fraction and percentage of fractional shortening (%Delta S) (by 35,3 and 3 5,7%, respectively). Perindopril exerted most pronounced hemodynamic effect in patients of group 2: after 1 month of therapy end systolic and end dias tolic volumes decreased by 8,7 and 14,8%, respectively (p<0,05) while elect ion fraction and %Delta S increased by 18,3 and 19,8%, respectively (p<0,05 ). This effect was sustained during further follow-up. Changes of parameter s of diastolic function by the end of therapy were similar in both groups.