Effects of early use of captopril on haemodynamics and short-term ventricular remodelling in acute anterior myocardial infarction

To determine whether ventricular short-term enlargement following acute myocardial infarction is related to increased left filling pressures and whether early treatment with captopril alters this process we studied 68 patients with a first acute myocardial infarction. Forty patients with a pulmonary capillary pressure equal or above 17 mm Hg were randomized to treatment with conventional therapy plus captopril(n 20) or placebo(n 20), in a double blind fashion. Tile remaining 28 patients (non-dysfunction group) were treated conventionally. During the first 72 h, afterload showed a prompt decrease in the captopril group as compared to placebo. Changes from baseline to 14 days in end-diastolic and end-systolic left ventricular volume indexes determined by radionuclide ventriculography were: non-dysfunction, 85.6( ± 21) vs 88(±20) and 44(±17) vs 44(±17)ml. m−2 captopril(n20), 96.6(±18) vs 99(±19) and 66(±22) vs 65(±22)ml. m−2; placebo(n 20), 96(±25) vs 113(±19) (P <0.001) and 63(±18) vs 74(±22)ml. m−2 (P <0.01) This study indicates that short-term ventricular enlargement is related to the degree of ventricular dysfunction and that captopril may improve this process.