November 1, 1993Circulation
Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dilatation in patients with asymptomatic systolic dysfunction. SOLVD (Studies of Left Ventricular Dysfunction) Investigators.
Why the study?
Does enalapril reduce left ventricular dilatation in patients with asymptomatic systolic dysfunction?
Population
108 patients with asymptomatic left ventricular systolic dysfunction enrolled in the SOLVD Prevention Trial.
Comparison
Enalapril 2.5 to 20 mg/d vs Placebo
Design
RCT, randomization, double-blinded
Follow-up
1 year (catheterization) and mean 25 months (radionuclide)
Authors
Discussion
Loading...
Member takes
Implication
Supports enalapril initiation in asymptomatic left ventricular dysfunction to limit dilatation; extends remodeling benefit from symptomatic to pre–heart failure populations.
Key Points
- To assess whether chronic enalapril therapy slows or reverses progressive left ventricular dilatation in patients with asymptomatic left ventricular systolic dysfunction.
- Double-blind randomized trial evaluating enalapril (2.5 to 20 mg/day) versus placebo in 108 patients with left ventricular ejection fraction ≤ 0.35 and no clinical heart failure.
- Left ventricular end-diastolic volume (EDV) was measured using radionuclide ventriculography (n=108, mean follow-up 25 months) and left heart catheterization (n=49, at 1 year).
- Radionuclide EDV decreased from 120 ± 25 to 113 ± 25 mL/m² in the enalapril group and increased from 119 ± 28 to 124 ± 33 mL/m² in the placebo group (P < 0.05).
- Catheterization confirmed a significant difference in EDV change between enalapril and placebo at 1 year (P < 0.05).
- Overall volume changes were smaller in magnitude compared to patients with symptomatic heart failure (P < 0.02).
Structured PICO
Does enalapril reduce left ventricular dilatation in patients with asymptomatic systolic dysfunction?
P
Population
108 patients with asymptomatic left ventricular systolic dysfunction (LVEF <= 0.35 but without clinical heart failure) enrolled in the SOLVD Prevention Trial.
I
Intervention
Enalapril 2.5 to 20 mg/d
C
Comparator
Placebo
O
Outcome
Change in end-diastolic volume (EDV)surrogate
Chronic enalapril treatment slows or reverses left ventricular dilatation in patients with asymptomatic LV systolic dysfunction, although the magnitude of benefit is smaller than in symptomatic patients.
Cite This Study
Konstam et al. (1993) studied this question.