AS MEDIDAS QUANTITATIVAS DA ECOCARDIOGRAFIA BIDIMENSIONAL SAO OS MAIORES PREDITORES DE EVENTOS CARDIOVASCULARES ADVERSOS APOS INFARTO AGUDO DO MIOCARDIO. OS EFEITOS PROTETORES DO CAPTOPRIL

Translated title of the contribution: Quantitative two-dimensional echocardiographic measurements are major predictors of adverse cardiovascular events after acute myocardial infarction. The protective effects of captopril

M. S J Sutton, M. A. Pfeffer, T. Plappert, J. L. Rouleau, L. A. Moye, G. R. Dagenais, G. A. Lamas, M. Klein, B. Sussex, Steven Goldman, F. J. Menapace, J. O. Parker, J. O. Lewis, F. Sestier, D. F. Gordon, P. McEwan, V. Bernstein, E. Braunwald

Research output: Contribution to journalArticle

Abstract

Background. Left ventricular enlargement after myocardial infarction increases the likelihood of an adverse outcome. In an echocardiographic substudy of the Survival and Ventricular Enlargement (SAVE) Trial, we assessed whether captopril would attenuate progressive left ventricular enlargement in patients with left ventricular dysfunction after acute myocardial infarction and, if so, whether this would be associated with improved clinical outcome. Methods and results. Two-dimensional transthoracic echocardiograms were obtained in 512 patients at a mean of 11.1 ± 5.2 days after infarction and were repeated at 1 year in 420 survivors. Left ventricular size was assessed as left ventricular cavity areas at end diastole and end systole and left ventricular function as percent change in cavity area from end diastole to end systole. Patients were randomly assigned to placebo or captopril, and the incidence of adverse cardiovascular events consisting of cardiovascular death, heart failure requiring either hospitalization or open label angiotensin-converting enzyme inhibitor therapy and recurrent infarcticn were determined over a follow-up period averaging 3.0 ± 0.6 years. Irrespective of treatment assignment, baseline left ventricular systolic area and percent change in area were strong predictors of cardiovascular mortality and adverse cardiovascular events. At one year, left ventricular end diastolic and end-systolic areas were larger in the placebo than in the captopril group (p = 0.038, p = 0.015, respectively), and percent change in cavity area was greater in the captopril group (p = 0.005). One hundred eleven of the 420 1-year survivors with 1-year echo measurements (26.4%) experienced a major adverse cardiovascular event, and these patients had more than a threefold greater increase in left ventricular cavity areas than those with an uncomplicated course. Sixty-nine patients with adverse cardiovascular events were in the placebo group compared with 42 patients in the captopril-treated group (a risk reduction of 35%, p = 0.010). Conclusions. Two-dimensional echocardiography provides important and independent prognostic information in patients after infarction. Left ventricular enlargement and function after infarction are associated with the development of adverse cardiac events. Attenuation of ventricular enlargement with captopril in these patients was associated with a reduction in adverse events. This study demonstrates the linkage between attenuaticn of left ventricular enlargement by captopril after infarction and improved clinical outcome.

Original languageUndefined/Unknown
Pages (from-to)335-343
Number of pages9
JournalArquivos Brasileiros de Medicina
Volume68
Issue number5
StatePublished - 1994
Externally publishedYes

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Captopril
Myocardial Infarction
Infarction
Diastole
Systole
Placebos
Left Ventricular Function
Survivors
Enzyme Therapy
Left Ventricular Dysfunction
Risk Reduction Behavior
Angiotensin-Converting Enzyme Inhibitors
Echocardiography
Hospitalization
Heart Failure
Survival
Mortality
Incidence

ASJC Scopus subject areas

  • Medicine(all)

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AS MEDIDAS QUANTITATIVAS DA ECOCARDIOGRAFIA BIDIMENSIONAL SAO OS MAIORES PREDITORES DE EVENTOS CARDIOVASCULARES ADVERSOS APOS INFARTO AGUDO DO MIOCARDIO. OS EFEITOS PROTETORES DO CAPTOPRIL. / Sutton, M. S J; Pfeffer, M. A.; Plappert, T.; Rouleau, J. L.; Moye, L. A.; Dagenais, G. R.; Lamas, G. A.; Klein, M.; Sussex, B.; Goldman, Steven; Menapace, F. J.; Parker, J. O.; Lewis, J. O.; Sestier, F.; Gordon, D. F.; McEwan, P.; Bernstein, V.; Braunwald, E.

In: Arquivos Brasileiros de Medicina, Vol. 68, No. 5, 1994, p. 335-343.

Research output: Contribution to journalArticle

Sutton, MSJ, Pfeffer, MA, Plappert, T, Rouleau, JL, Moye, LA, Dagenais, GR, Lamas, GA, Klein, M, Sussex, B, Goldman, S, Menapace, FJ, Parker, JO, Lewis, JO, Sestier, F, Gordon, DF, McEwan, P, Bernstein, V & Braunwald, E 1994, 'AS MEDIDAS QUANTITATIVAS DA ECOCARDIOGRAFIA BIDIMENSIONAL SAO OS MAIORES PREDITORES DE EVENTOS CARDIOVASCULARES ADVERSOS APOS INFARTO AGUDO DO MIOCARDIO. OS EFEITOS PROTETORES DO CAPTOPRIL', Arquivos Brasileiros de Medicina, vol. 68, no. 5, pp. 335-343.
Sutton, M. S J ; Pfeffer, M. A. ; Plappert, T. ; Rouleau, J. L. ; Moye, L. A. ; Dagenais, G. R. ; Lamas, G. A. ; Klein, M. ; Sussex, B. ; Goldman, Steven ; Menapace, F. J. ; Parker, J. O. ; Lewis, J. O. ; Sestier, F. ; Gordon, D. F. ; McEwan, P. ; Bernstein, V. ; Braunwald, E. / AS MEDIDAS QUANTITATIVAS DA ECOCARDIOGRAFIA BIDIMENSIONAL SAO OS MAIORES PREDITORES DE EVENTOS CARDIOVASCULARES ADVERSOS APOS INFARTO AGUDO DO MIOCARDIO. OS EFEITOS PROTETORES DO CAPTOPRIL. In: Arquivos Brasileiros de Medicina. 1994 ; Vol. 68, No. 5. pp. 335-343.
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title = "AS MEDIDAS QUANTITATIVAS DA ECOCARDIOGRAFIA BIDIMENSIONAL SAO OS MAIORES PREDITORES DE EVENTOS CARDIOVASCULARES ADVERSOS APOS INFARTO AGUDO DO MIOCARDIO. OS EFEITOS PROTETORES DO CAPTOPRIL",
abstract = "Background. Left ventricular enlargement after myocardial infarction increases the likelihood of an adverse outcome. In an echocardiographic substudy of the Survival and Ventricular Enlargement (SAVE) Trial, we assessed whether captopril would attenuate progressive left ventricular enlargement in patients with left ventricular dysfunction after acute myocardial infarction and, if so, whether this would be associated with improved clinical outcome. Methods and results. Two-dimensional transthoracic echocardiograms were obtained in 512 patients at a mean of 11.1 ± 5.2 days after infarction and were repeated at 1 year in 420 survivors. Left ventricular size was assessed as left ventricular cavity areas at end diastole and end systole and left ventricular function as percent change in cavity area from end diastole to end systole. Patients were randomly assigned to placebo or captopril, and the incidence of adverse cardiovascular events consisting of cardiovascular death, heart failure requiring either hospitalization or open label angiotensin-converting enzyme inhibitor therapy and recurrent infarcticn were determined over a follow-up period averaging 3.0 ± 0.6 years. Irrespective of treatment assignment, baseline left ventricular systolic area and percent change in area were strong predictors of cardiovascular mortality and adverse cardiovascular events. At one year, left ventricular end diastolic and end-systolic areas were larger in the placebo than in the captopril group (p = 0.038, p = 0.015, respectively), and percent change in cavity area was greater in the captopril group (p = 0.005). One hundred eleven of the 420 1-year survivors with 1-year echo measurements (26.4{\%}) experienced a major adverse cardiovascular event, and these patients had more than a threefold greater increase in left ventricular cavity areas than those with an uncomplicated course. Sixty-nine patients with adverse cardiovascular events were in the placebo group compared with 42 patients in the captopril-treated group (a risk reduction of 35{\%}, p = 0.010). Conclusions. Two-dimensional echocardiography provides important and independent prognostic information in patients after infarction. Left ventricular enlargement and function after infarction are associated with the development of adverse cardiac events. Attenuation of ventricular enlargement with captopril in these patients was associated with a reduction in adverse events. This study demonstrates the linkage between attenuaticn of left ventricular enlargement by captopril after infarction and improved clinical outcome.",
author = "Sutton, {M. S J} and Pfeffer, {M. A.} and T. Plappert and Rouleau, {J. L.} and Moye, {L. A.} and Dagenais, {G. R.} and Lamas, {G. A.} and M. Klein and B. Sussex and Steven Goldman and Menapace, {F. J.} and Parker, {J. O.} and Lewis, {J. O.} and F. Sestier and Gordon, {D. F.} and P. McEwan and V. Bernstein and E. Braunwald",
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T1 - AS MEDIDAS QUANTITATIVAS DA ECOCARDIOGRAFIA BIDIMENSIONAL SAO OS MAIORES PREDITORES DE EVENTOS CARDIOVASCULARES ADVERSOS APOS INFARTO AGUDO DO MIOCARDIO. OS EFEITOS PROTETORES DO CAPTOPRIL

AU - Sutton, M. S J

AU - Pfeffer, M. A.

AU - Plappert, T.

AU - Rouleau, J. L.

AU - Moye, L. A.

AU - Dagenais, G. R.

AU - Lamas, G. A.

AU - Klein, M.

AU - Sussex, B.

AU - Goldman, Steven

AU - Menapace, F. J.

AU - Parker, J. O.

AU - Lewis, J. O.

AU - Sestier, F.

AU - Gordon, D. F.

AU - McEwan, P.

AU - Bernstein, V.

AU - Braunwald, E.

PY - 1994

Y1 - 1994

N2 - Background. Left ventricular enlargement after myocardial infarction increases the likelihood of an adverse outcome. In an echocardiographic substudy of the Survival and Ventricular Enlargement (SAVE) Trial, we assessed whether captopril would attenuate progressive left ventricular enlargement in patients with left ventricular dysfunction after acute myocardial infarction and, if so, whether this would be associated with improved clinical outcome. Methods and results. Two-dimensional transthoracic echocardiograms were obtained in 512 patients at a mean of 11.1 ± 5.2 days after infarction and were repeated at 1 year in 420 survivors. Left ventricular size was assessed as left ventricular cavity areas at end diastole and end systole and left ventricular function as percent change in cavity area from end diastole to end systole. Patients were randomly assigned to placebo or captopril, and the incidence of adverse cardiovascular events consisting of cardiovascular death, heart failure requiring either hospitalization or open label angiotensin-converting enzyme inhibitor therapy and recurrent infarcticn were determined over a follow-up period averaging 3.0 ± 0.6 years. Irrespective of treatment assignment, baseline left ventricular systolic area and percent change in area were strong predictors of cardiovascular mortality and adverse cardiovascular events. At one year, left ventricular end diastolic and end-systolic areas were larger in the placebo than in the captopril group (p = 0.038, p = 0.015, respectively), and percent change in cavity area was greater in the captopril group (p = 0.005). One hundred eleven of the 420 1-year survivors with 1-year echo measurements (26.4%) experienced a major adverse cardiovascular event, and these patients had more than a threefold greater increase in left ventricular cavity areas than those with an uncomplicated course. Sixty-nine patients with adverse cardiovascular events were in the placebo group compared with 42 patients in the captopril-treated group (a risk reduction of 35%, p = 0.010). Conclusions. Two-dimensional echocardiography provides important and independent prognostic information in patients after infarction. Left ventricular enlargement and function after infarction are associated with the development of adverse cardiac events. Attenuation of ventricular enlargement with captopril in these patients was associated with a reduction in adverse events. This study demonstrates the linkage between attenuaticn of left ventricular enlargement by captopril after infarction and improved clinical outcome.

AB - Background. Left ventricular enlargement after myocardial infarction increases the likelihood of an adverse outcome. In an echocardiographic substudy of the Survival and Ventricular Enlargement (SAVE) Trial, we assessed whether captopril would attenuate progressive left ventricular enlargement in patients with left ventricular dysfunction after acute myocardial infarction and, if so, whether this would be associated with improved clinical outcome. Methods and results. Two-dimensional transthoracic echocardiograms were obtained in 512 patients at a mean of 11.1 ± 5.2 days after infarction and were repeated at 1 year in 420 survivors. Left ventricular size was assessed as left ventricular cavity areas at end diastole and end systole and left ventricular function as percent change in cavity area from end diastole to end systole. Patients were randomly assigned to placebo or captopril, and the incidence of adverse cardiovascular events consisting of cardiovascular death, heart failure requiring either hospitalization or open label angiotensin-converting enzyme inhibitor therapy and recurrent infarcticn were determined over a follow-up period averaging 3.0 ± 0.6 years. Irrespective of treatment assignment, baseline left ventricular systolic area and percent change in area were strong predictors of cardiovascular mortality and adverse cardiovascular events. At one year, left ventricular end diastolic and end-systolic areas were larger in the placebo than in the captopril group (p = 0.038, p = 0.015, respectively), and percent change in cavity area was greater in the captopril group (p = 0.005). One hundred eleven of the 420 1-year survivors with 1-year echo measurements (26.4%) experienced a major adverse cardiovascular event, and these patients had more than a threefold greater increase in left ventricular cavity areas than those with an uncomplicated course. Sixty-nine patients with adverse cardiovascular events were in the placebo group compared with 42 patients in the captopril-treated group (a risk reduction of 35%, p = 0.010). Conclusions. Two-dimensional echocardiography provides important and independent prognostic information in patients after infarction. Left ventricular enlargement and function after infarction are associated with the development of adverse cardiac events. Attenuation of ventricular enlargement with captopril in these patients was associated with a reduction in adverse events. This study demonstrates the linkage between attenuaticn of left ventricular enlargement by captopril after infarction and improved clinical outcome.

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