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Changes in ventricular size and function in patients treated with valsartan, captopril, or both after myocardial infarction.
Circulation. 2005 Jun 28; 111(25):3411-9.Circ

Abstract

BACKGROUND

Angiotensin-converting enzyme (ACE) inhibitors have been shown to attenuate left ventricular (LV) enlargement in association with reducing mortality after myocardial infarction (MI). Preclinical data suggest that angiotensin receptor blockers (ARBs) may have similar structural and functional effects after MI. The Valsartan in Acute Myocardial Infarction (VALIANT) Echo study was designed to test the hypothesis that the ARB valsartan, either alone or in combination with captopril, could attenuate progressive LV enlargement or improve LV ejection fraction to a greater extent than captopril alone.

METHODS AND RESULTS

Six hundred ten patients enrolled in the main VALIANT study who experienced MI and evidence of LV dysfunction, heart failure, or both were enrolled in the VALIANT Echo study. Patients were randomized to receive valsartan 160 mg PO BID, captopril 50 mg PO TID, or valsartan 80 mg PO BID plus captopril 50 mg PO TID between 1 and 10 days after MI. Six hundred three patients had echocardiograms of sufficient quality for quantitative analysis. Echocardiograms were digitized, and endocardial borders were traced manually from 2 short-axis and 2 apical views. Ventricular volumes, ejection fractions, combined areas, and infarct segment length were measured, and changes in echocardiographic measures from baseline to 20 months were compared between treatment groups. Baseline clinical and echocardiographic characteristics were similar in the 3 treatment arms. The changes from baseline to 20 months in all echocardiographic parameters were similar in all 3 treatment arms. Baseline echocardiographic measures of ejection fraction, end-diastolic volume, and infarct segment length were highly predictive of outcomes including total mortality, death or hospitalization for heart failure, or death or any cardiovascular event (heart failure, MI, stroke, resuscitated sudden death), even after adjustment for known covariates.

CONCLUSIONS

Treatment with the ACE inhibitor captopril, valsartan, or the combination of captopril plus valsartan resulted in similar changes in cardiac volume, ejection fraction, and infarct segment length between baseline and 20 months after MI. Baseline echocardiographic measures were powerfully and independently predictive of all major outcomes.

Authors+Show Affiliations

Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA. ssolomon@rics.bwh.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15967846

Citation

Solomon, Scott D., et al. "Changes in Ventricular Size and Function in Patients Treated With Valsartan, Captopril, or Both After Myocardial Infarction." Circulation, vol. 111, no. 25, 2005, pp. 3411-9.
Solomon SD, Skali H, Anavekar NS, et al. Changes in ventricular size and function in patients treated with valsartan, captopril, or both after myocardial infarction. Circulation. 2005;111(25):3411-9.
Solomon, S. D., Skali, H., Anavekar, N. S., Bourgoun, M., Barvik, S., Ghali, J. K., Warnica, J. W., Khrakovskaya, M., Arnold, J. M., Schwartz, Y., Velazquez, E. J., Califf, R. M., McMurray, J. V., & Pfeffer, M. A. (2005). Changes in ventricular size and function in patients treated with valsartan, captopril, or both after myocardial infarction. Circulation, 111(25), 3411-9.
Solomon SD, et al. Changes in Ventricular Size and Function in Patients Treated With Valsartan, Captopril, or Both After Myocardial Infarction. Circulation. 2005 Jun 28;111(25):3411-9. PubMed PMID: 15967846.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Changes in ventricular size and function in patients treated with valsartan, captopril, or both after myocardial infarction. AU - Solomon,Scott D, AU - Skali,Hicham, AU - Anavekar,Nagesh S, AU - Bourgoun,Mikhail, AU - Barvik,Stale, AU - Ghali,Jalal K, AU - Warnica,J Wayne, AU - Khrakovskaya,Margarita, AU - Arnold,J Malcolm O, AU - Schwartz,Yuri, AU - Velazquez,Eric J, AU - Califf,Robert M, AU - McMurray,John V, AU - Pfeffer,Marc A, Y1 - 2005/06/20/ PY - 2005/6/22/pubmed PY - 2006/2/4/medline PY - 2005/6/22/entrez SP - 3411 EP - 9 JF - Circulation JO - Circulation VL - 111 IS - 25 N2 - BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors have been shown to attenuate left ventricular (LV) enlargement in association with reducing mortality after myocardial infarction (MI). Preclinical data suggest that angiotensin receptor blockers (ARBs) may have similar structural and functional effects after MI. The Valsartan in Acute Myocardial Infarction (VALIANT) Echo study was designed to test the hypothesis that the ARB valsartan, either alone or in combination with captopril, could attenuate progressive LV enlargement or improve LV ejection fraction to a greater extent than captopril alone. METHODS AND RESULTS: Six hundred ten patients enrolled in the main VALIANT study who experienced MI and evidence of LV dysfunction, heart failure, or both were enrolled in the VALIANT Echo study. Patients were randomized to receive valsartan 160 mg PO BID, captopril 50 mg PO TID, or valsartan 80 mg PO BID plus captopril 50 mg PO TID between 1 and 10 days after MI. Six hundred three patients had echocardiograms of sufficient quality for quantitative analysis. Echocardiograms were digitized, and endocardial borders were traced manually from 2 short-axis and 2 apical views. Ventricular volumes, ejection fractions, combined areas, and infarct segment length were measured, and changes in echocardiographic measures from baseline to 20 months were compared between treatment groups. Baseline clinical and echocardiographic characteristics were similar in the 3 treatment arms. The changes from baseline to 20 months in all echocardiographic parameters were similar in all 3 treatment arms. Baseline echocardiographic measures of ejection fraction, end-diastolic volume, and infarct segment length were highly predictive of outcomes including total mortality, death or hospitalization for heart failure, or death or any cardiovascular event (heart failure, MI, stroke, resuscitated sudden death), even after adjustment for known covariates. CONCLUSIONS: Treatment with the ACE inhibitor captopril, valsartan, or the combination of captopril plus valsartan resulted in similar changes in cardiac volume, ejection fraction, and infarct segment length between baseline and 20 months after MI. Baseline echocardiographic measures were powerfully and independently predictive of all major outcomes. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/15967846/Changes_in_ventricular_size_and_function_in_patients_treated_with_valsartan_captopril_or_both_after_myocardial_infarction_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.104.508093?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -