| Early neurohormonal effects of trandolapril in patients with left ventricular dysfunction and a recent acute myocardial infarction: a double-blind, randomized, placebo-controlled multicentre study. | |
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MedLine Citation:
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PMID: 11163738 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Angiotensin-converting enzyme inhibitors improve long-term survival in patients with left ventricular dysfunction after a myocardial infarction, but their mechanism of action is not entirely clear. The neurohormonal effects may be important in this respect, as well as an early hemodynamic unloading induced by these drugs. The primary objective was to assess the effect of trandolapril on plasma levels of atrial natriuretic peptide. A secondary objective was to assess the effects of trandolapril on selected neurohormones, vasoactive peptides and enzymes, which may be important in the development of left ventricular remodeling and heart failure following an acute myocardial infarction. A total of 119 patients with an acute myocardial infarction and a wall motion index < or =1.2 (16-segment echocardiographic model) were randomized to double blind treatment with trandolapril or placebo within 3-7 days after the onset of infarction. Blind treatment was discontinued 21 days after the index infarction. Venous blood samples were collected at rest, before randomization and on the day after treatment was discontinued. At the end of the study, there were no differences in plasma levels of atrial natriuretic peptide between the two treatment groups. Angiotensin-converting enzyme activity was suppressed and plasma renin activity was higher in the trandolapril group. No differences in plasma levels of N-terminal pro-atrial natriuretic peptide, brain natriuretic peptide, aldosterone, noradrenaline, adrenaline, vasopressin, big endothelin-1 and neuropeptide Y were found between the two treatment groups. There were positive correlations between several markers of neurohormonal activation at baseline and variables expressing left ventricular dysfunction and clinical heart failure. Neurohormonal activation is related to left ventricular dysfunction. The effects of 2-3 weeks of angiotensin-converting enzyme inhibition on neurohormonal activation does not predict the already established beneficial long-term effects after myocardial infarction. Thus, early modulation of circulatory neurohormone levels may not be a major mechanism for the efficacy of angiotensin-converting enzyme inhibitors in these patients. Selected plasma hormone markers may still be used to identify patients who might get the greatest benefit from treatment. |
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Authors:
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A Sigurdsson; S V Eriksson; C Hall; T Kahan; K Swedberg |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial |
Journal Detail:
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Title: European journal of heart failure Volume: 3 ISSN: 1388-9842 ISO Abbreviation: Eur. J. Heart Fail. Publication Date: 2001 Jan |
Date Detail:
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Created Date: 2001-02-22 Completed Date: 2001-04-26 Revised Date: 2011-06-08 |
Medline Journal Info:
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Nlm Unique ID: 100887595 Medline TA: Eur J Heart Fail Country: Netherlands |
Other Details:
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Languages: eng Pagination: 69-78 Citation Subset: IM |
Affiliation:
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Department of Medicine, Division of Cardiology, Landspitalinn v. Hringbraut, 101, Reykjavik, Iceland. axelfsig@rsp.is |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Analysis of Variance Angiotensin-Converting Enzyme Inhibitors / therapeutic use* Atrial Natriuretic Factor / blood* Double-Blind Method Female Humans Indoles / therapeutic use* Male Myocardial Infarction / blood*, complications, drug therapy* Neurotransmitter Agents / blood* Renin / blood Ventricular Dysfunction, Left / blood*, drug therapy*, etiology |
| Chemical | |
Reg. No./Substance:
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0/Angiotensin-Converting Enzyme Inhibitors; 0/Indoles; 0/Neurotransmitter Agents; 85637-73-6/Atrial Natriuretic Factor; 87679-37-6/trandolapril; EC 3.4.23.15/Renin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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