Angiotensin-converting enzyme inhibitor therapy affects myocardial fatty acid metabolism after acute myocardial infarction

Background, Angiotensin-converting enzyme (ACE) inhibitor therapy has an ea rly mortality benefit in unselected patients with acute myocardial infarcti on (AMI), However, the effects of ACE inhibition on myocardial fatty acid m etabolism in this patient population have not been studied. We tested the h ypothesis that ACE inhibitor therapy improves myocardial fatty acid metabol ism and decreases mortality rate in patients after AMI. Methods. Forty-two patients after first anterior AMI and primary angioplast y were randomly assigned to titrated oral enalapril (n = 24) or placebo the rapy (n = 18), Iodine 123-labeled 15-(p-iodophenyl)-3-(R,S)-methylpentadeca noic acid (BMIPP) single photon emission computed tomography imaging was pe rformed an average of 4.8 days after AMI and 1 month after AMI. BMIPP abnor malities were quantified as a severity index by a polar map. Results. There were no significant changes in baseline characteristics, car diac function, and angiographic findings between patients in the enalapril group and patients in the placebo group. However, BMIPP severity index from acute phase to chronic phase was significantly decreased in the enalapril- treated group (118 +/- 48 to 82 +/- 36, P < .05), but not in the placebo gr oup (123 +/- 65 to 115 +/- 58, P not significant). Conclusion. ACE inhibition therapy improved myocardial fatty acid metabolis m and regional left ventricular function in patients after anterior AMI. BM IPP single photon emission computed tomography findings imply that this bet ter outcome may be attributable to an improvement of cellular function with ACE inhibitors.