Abstract:
BACKGROUND:Angiotensin-converting enzyme inhibitors have been shown to attenuate adverse remodeling after acute myocardial infarction (AMI), and the same has been suggested for angiotensin II type 1 receptor antagonists in animal models. Therefore the aim of the study was to compare the effects of losartan and captopril on regional systolic, diastolic, and overall left ventricular (LV) function after AMI. METHODS:Two hundred twenty-five patients aged > or =50 years with documented AMI and heart failure and/or LV dysfunction were randomly assigned treatment with either losartan (50 mg/d) or captopril (50 mg 3 times/d). Echocardiography was performed at randomization and after 3 months; echocardiograms were analyzed blinded at the core laboratory. Main outcome measures were changes in wall motion score index (WMSI), E-wave deceleration time (E-DT), and Tei index of overall LV function. RESULTS:WMSI decreased in both groups (losartan 1.58 +/- 0.23 to 1.52 +/- 0.26, P =.009, captopril 1.60 +/- 0.24 to 1.48 +/- 0.22, P <.001), although the decrease was greater in patients allocated to captopril (captopril -0.12 +/- 0.17 vs losartan -0.05 +/- 0.19, P =.007). In both groups E-DT increased, although the increase was significant only in patients treated with captoril (193 +/- 61 ms to 208 +/- 70 ms, P =.05). The change in E-DT was not different between treatment groups (captopril 14 +/- 74 ms vs losartan 7 +/- 80 ms, P =.52). Tei index decreased in both groups (losartan 0.59 +/- 0.13 to 0.55 +/- 0.15, P =.04, captopril 0.62 +/- 0.15 to 0.55 +/- 0.13, P <.001). However, the reduction was significantly greater in patients treated with captopril (captopril -0.08 +/- 0.14 vs losartan -0.03 +/- 0.14, P =.01). CONCLUSION:Losartan and captopril improve systolic and overall LV function after AMI, but the benefit is greater for patients treated with captopril.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Møller JE,Dahlström U,Gøtzsche O,Lahiri A,Skagen K,Andersen GS,Egstrup K,OPTIMAAL Study Group.doi
10.1016/j.ahj.2003.10.031subject
Has Abstractpub_date
2004-03-01 00:00:00pages
494-501issue
3eissn
0002-8703issn
1097-6744pii
S0002870303007762journal_volume
147pub_type
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