Clinical research: left ventricular mass in cardiac disease
Effects of ramipril on left ventricular mass and function in cardiovascular patients with controlled blood pressure and with preserved left ventricular ejection fraction: A substudy of the Heart Outcomes Prevention Evaluation (HOPE) trial

https://doi.org/10.1016/j.jacc.2003.10.073Get rights and content
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Abstract

Objectives

The purpose of this study was to assess the effects of ramipril on left ventricular mass (LVM) and function in vascular disease patients with controlled blood pressure (BP) and with preserved left ventricular ejection fraction (LVEF).

Background

Increased LVM and left ventricular (LV) volume and decreased LVEF predict clinical events. Angiotensin-converting enzyme inhibitors reduce LVM and LV volume and preserve LVEF in patients with hypertension and/or LV dysfunction, but have not been studied in patients with controlled BP and preserved LVEF.

Methods

We compared the effects of two doses of ramipril (10 mg/day and 2.5 mg/day) versus placebo in 506 patients with vascular disease on echocardiographic measures of LVM and LV function.

Results

Baseline BP and LVEF were similar, 131/76 mm Hg and 58%, in all treatment groups. After four years, LVM index increased by 3.98 ± 2.08 g/m2in the placebo and by 4.16 ± 1.86 g/m2in the ramipril 2.5 mg/day groups and decreased by 2.02 ± 2.25 g/m2in the ramipril 10 mg/day group (p = 0.02). The changes in LV end-diastolic and end-systolic volumes were 4.16 ± 2.55 ml and 5.31 ± 1.67 ml in the placebo, −0.43 ± 2.75 ml and 2.90 ± 1.45 ml in the ramipril 2.5 mg/day, and −5.90 ± 2.93 ml and −1.90 ± 1.55 ml in the ramipril 10 mg/day groups (p = 0.02 and p = 0.001). The changes in LVEF were −2.02 ± 0.72%, −1.54 ± 0.74%, and −0.17 ± 0.72%, respectively (p = 0.01).

Conclusions

Ramipril has beneficial effects on LV structure and function in vascular patients with controlled BP and with preserved LVEF.

Abbreviations

ACE
angiotensin-converting enzyme
ASE
American Society of Echocardiography
BP
blood pressure
HOPE
Heart Outcomes Prevention Evaluation trial
LV
left ventricle/ventricular
LVEDV
left ventricular end-diastolic volume
LVEF
left ventricular ejection fraction
LVESV
left ventricular end-systolic volume
LVM
left ventricular mass
LVMI
left ventricular mass index
NWMAB
new wall motion abnormalities
WMS
wall motion score

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The study was partially funded by the Medical Research Council of Canada, grants UI-12362 and UI 12363.