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European Heart Journal Advance Access originally published online on April 30, 2009
European Heart Journal 2009 30(13):1656-1665; doi:10.1093/eurheartj/ehp139
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Effects of perindopril on cardiac remodelling and prognostic value of pre-discharge quantitative echocardiographic parameters in elderly patients after acute myocardial infarction: the PREAMI echo sub-study

Gian Luigi Nicolosi1, Sorin Golcea2,3, Claudio Ceconi2,3, Giovanni Parrinello4, Adriano Decarli5, Massimo Chiariello6, Willem J. Remme7, Luigi Tavazzi8, Roberto Ferrari2,3,* on behalf of the PREAMI Investigators

1 Department of Cardiology, A.R.C., Pordenone, Italy
2 University of Ferrara, Arcispedale S. Anna, Corso Giovecca 203, 44100, Ferrara, Italy
3 Cardiovascular Pathophysiology Research Centre ‘Salvatore Maugeri’ Foundation, IRCCS, Gussago, Brescia, Italy
4 Medical Statistics, University of Brescia, Italy
5 Institute of Biometry, University of Milan, Italy
6 University of Naples, Italy
7 Sticares Cardiovascular Research Foundation, Rotterdam-Rhoon, The Netherlands
8 Policlinico San Matteo, Pavia, Italy

Received 16 July 2008; revised 11 March 2009; accepted 13 March 2009; online publish-ahead-of-print 30 April 2009.

* Corresponding author. Tel: +39 0532 20 21 43, Fax: +39 0532 24 18 85, Email: fri{at}unife.it

Aims: To determine (i) the effect of perindopril on several geometric and functional parameters of the left and right ventricles assessed by echocardiography in the unique Perindopril and Remodelling in Elderly with Acute Myocardial Infarction (PREAMI) population of post-acute myocardial infarction (AMI) elderly patients with preserved left ventricular (LV) function; and (ii) the prognostic predictors at pre-discharge derived from echo-Doppler measurements in the same population.

Methods and results: PREAMI included 1252 post-AMI patients (age 73 ± 6 years, LV ejection fraction 59.1 ± 7.7%) receiving optimal therapy after AMI, randomized to perindopril 8 mg/day (n = 631) or placebo (n = 621); n = 896 had complete echo-Doppler data. Outcome measures were clinical [death, heart failure (HF)] and standard echo-Doppler parameters. Pre-discharge LV end-diastolic volume (LVEDV) was similar: 81.1 ± 23.1 (perindopril) and 79.6 ± 22.7 mL (placebo). At 6 months and 1 year, LVEDV remained unchanged with perindopril (81.2 ± 24.4 and 81.8 ± 26.8 mL, respectively), but increased with placebo (83.0 ± 25.3 and 83.6 ± 25.7 mL, respectively, both P < 0.001 vs. baseline). Perindopril reduced cardiac sphericity vs. placebo (P = 0.015 at 6 months; P = 0.020 at 1 year). Classification regression tree analysis showed treatment as the most important predictor of remodelling. Multiple pre-discharge echocardiographic variables predicted the death/HF endpoint, independently of treatment (P ≤ 0.05).

Conclusion: Remodelling occurs in post-AMI in elderly patients with normal LV function. Echo-Doppler variables at baseline have prognostic implications. Treatment with perindopril reduces progressive LV remodelling that can occur even in the case of small infarct size.

Key Words: Echocardiography • Myocardial infarction • Perindopril • Prognosis • Remodelling


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