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.

2.50
Hdl Handle:
http://hdl.handle.net/2336/47296
Title:
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.
Authors:
Sigurdsson, A; Eriksson, S V; Hall, C; Kahan, T; Swedberg, K
Citation:
Eur. J. Heart Fail. 2001, 3(1):69-78
Issue Date:
1-Jan-2001
Abstract:
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.
Description:
To access publisher full text version of this article. Please click on the hyperlink in Additional Links field
Additional Links:
http://www.sciencedirect.com/science/article/B6VS9-423R99G-C/2/bb8e5e1062372618516a8c8604272e2f

Full metadata record

DC FieldValue Language
dc.contributor.authorSigurdsson, A-
dc.contributor.authorEriksson, S V-
dc.contributor.authorHall, C-
dc.contributor.authorKahan, T-
dc.contributor.authorSwedberg, K-
dc.date.accessioned2009-01-12T10:11:18Z-
dc.date.available2009-01-12T10:11:18Z-
dc.date.issued2001-01-01-
dc.date.submitted2009-01-12-
dc.identifier.citationEur. J. Heart Fail. 2001, 3(1):69-78en
dc.identifier.issn1388-9842-
dc.identifier.pmid11163738-
dc.identifier.doi10.1016/S1388-9842(00)00137-9-
dc.identifier.urihttp://hdl.handle.net/2336/47296-
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractAngiotensin-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.en
dc.language.isoenen
dc.publisherElsevier Scienceen
dc.relation.urlhttp://www.sciencedirect.com/science/article/B6VS9-423R99G-C/2/bb8e5e1062372618516a8c8604272e2fen
dc.subject.meshAgeden
dc.subject.meshAnalysis of Varianceen
dc.subject.meshAngiotensin-Converting Enzyme Inhibitorsen
dc.subject.meshAtrial Natriuretic Factoren
dc.subject.meshDouble-Blind Methoden
dc.subject.meshFemaleen
dc.subject.meshHumansen
dc.subject.meshIndolesen
dc.subject.meshMaleen
dc.subject.meshMyocardial Infarctionen
dc.subject.meshNeurotransmitter Agentsen
dc.subject.meshReninen
dc.subject.meshVentricular Dysfunction, Leften
dc.titleEarly neurohormonal effects of trandolapril in patients with left ventricular dysfunction and a recent acute myocardial infarction: a double-blind, randomized, placebo-controlled multicentre study.en
dc.typeArticleen
dc.contributor.departmentDepartment of Medicine, Division of Cardiology, Landspitalinn v. Hringbraut, 101, Reykjavik, Iceland. axelfsig@rsp.isen
dc.identifier.journalEuropean journal of heart failure : journal of the Working Group on Heart Failure of the European Society of Cardiologyen
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