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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

Eva Lonn, MD, MSc, FACC, FRCPC^*,*, Roya Shaikholeslami, MD^*, Qilong Yi, PhD, Jackie Bosch, MSc, Brian Sullivan, MD, FRCPC^*, Paul Tanser, MD, FACC, FRCPC^*, Alison Magi, RN and Salim Yusuf, MBBS, DPhil, FACC, FRCPC^*

^* Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
Princess Margaret Hospital, Toronto, Ontario, Canada

Manuscript received July 14, 2003; revised manuscript received October 22, 2003, accepted October 27, 2003.

^* Reprint requests and correspondence: Dr. Eva Lonn, Hamilton Health Sciences Corporation, General Site, 237 Barton Street East, Hamilton, Ontario, Canada, L8L 2X2.
lonnem{at}mcmaster.ca

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/m² in the placebo and by 4.16 ± 1.86 g/m² in the ramipril 2.5 mg/day groups and decreased by 2.02 ± 2.25 g/m² in 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 and Acronyms   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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