Effects of captopril treatment on left ventricular remodeling and function after anterior myocardial infarction: Comparison with digitalis

The effects of captopril and digoxin treatment on left ventricular remodeling and function after anterior myocardial infarction were evaluated in a randomized unblinded trial. Forty-two patients with a first transmural anterior myocardial infarction and a radionuclide left ventricular ejection fraction <40% were randomly assigned to treatment with captopril (Group A) or digoxin (Group B). The two groups had similar baseline hemodynamic, coronary angiographic, echocardiographic and radionuclide angiographic variables. Among the 40 patients (20 in each group) who were followed up for 1 year, echocardiographic end-diastolic and end-systolic volumes were unmodified in Group A and global wall motion index was improved (p < 0.01); in Group B, end-diastolic and end-systolic volumes increased (p < 0.001 for both) and global wall motion index was unchanged. Rest radionuclide ejection fraction increased significantly in both groups (p < 0.001, Group A; p < 0.005, Group B). A comparison of the changes in the considered variables bewteen the two groups after 1 year of treatment showed a difference in end-diastolic (p < 0.005) end-systolic volumes (p < 0.001) and global wall motion index (p < 0.005) without differences in radionuclide ejection fraction, which improved to a similar degree in both groups. The results of this study suggest that captopril therapy, started 7 to 10 days after symptom onset in patients with anterior myocardial infarction and an ejection fraction <40%, improves both left ventricular remodeling and function and prevents left ventricular enlargement and in these patients performs better than digitalis.