Mechanisms involved in cardiac enlargement and congestive heart failure development after acute myocardial infarction

Details

Serval ID
serval:BIB_855C487CB41E
Type
Article: article from journal or magazin.
Collection
Publications
Title
Mechanisms involved in cardiac enlargement and congestive heart failure development after acute myocardial infarction
Journal
Cardiology
Author(s)
Kleber  F. X., Nussberger  J., Niemoller  L., Doering  W.
ISSN
0008-6312 (Print)
Publication state
Published
Issued date
1992
Volume
81
Number
4-5
Pages
213-20
Notes
Clinical Trial
Journal Article
Randomized Controlled Trial
Abstract
For 3 months, we followed up 40 patients with acute myocardial infarction, 20 were randomly assigned to treatment with captopril and 20 to placebo, to elucidate mechanisms inducing left ventricular volume enlargement and development of congestive heart failure. Echocardiographic follow-up could be obtained in 28 patients, 11 of whom showed more than a 10% increase in left ventricular systolic and/or diastolic volumes (captopril n = 3/15, placebo n = 8/13, p = 0.05). Volume increase was significantly associated with an impairment in exercise capacity (VO2 max in patients with vs. without volume enlargement 24.7 +/- 1.7 vs. 29.5 +/- 1.9 ml O2/kg/min; p < 0.05). Plasma renin activity, angiotensin II and catecholamines were normal in the acute and chronic postinfarction phase in patients on placebo as well as in patients 12-24 h after captopril intake. Plasma atrial natriuretic peptide concentration (ANP) was increased immediately after myocardial infarction, but ANP levels almost normalized in patients with captopril treatment, while they continued to be elevated in patients on placebo. The only technical parameter able to predict left ventricular volume increases was the sphericity index (28.7 vs. 35.7; p = 0.07). We concluded that morphologic deformation and filling pressures as estimated from elevated ANP levels are major factors promoting remodelling following myocardial infarction. ACE inhibitors might exert their favorable effect predominantly by reducing filling pressure.
Keywords
Atrial Natriuretic Factor/blood Captopril/*therapeutic use Cardiac Volume/drug effects/physiology Double-Blind Method Epinephrine/blood Exercise Test/drug effects Female Heart Catheterization Heart Failure, Congestive/*drug therapy/physiopathology Hemodynamic Processes/drug effects/physiology Humans Hypertrophy, Left Ventricular/*drug therapy/physiopathology Male Middle Aged Myocardial Infarction/*drug therapy/physiopathology Norepinephrine/blood Prospective Studies Renin-Angiotensin System/*drug effects/physiology Ventricular Function, Left/drug effects/physiology
Pubmed
Web of science
Create date
05/03/2008 16:40
Last modification date
20/08/2019 14:44
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