Structural and Functional State of Left Ventricle and Efficacy of an Angiotensin Converting Enzyme Perindopril in Patients with Heart Failure after Myocardial Infarction: Relation to Angiotensin Converting Enzyme Gene Polymorphism
Aim. To study relationship between structural and functional state of left ventricle and angiotensin converting enzyme (ACE) genotype in patients with chronic heart failure after myocardial infarction and dependence of hemodynamic effects of an ACE inhibitor perindopril on ACE gene polymorphism. Material and methods. 52 patients with NYHA class III-IV heart failure after myocardial infarction. ACE genotypes were determined by polymerase chain reaction. Echocardiography was carried out before perindopril, in the end of titration phase, and in 6 and 12 months of therapy with perindopril. Results. II, ID and DD genotypes were found in 11 (21,1%), 20 (38,5%) and 21 (40,4%) patients, respectively. As there was no significant difference in initial hemodynamic parameters between patients with II and ID genotypes all patients were divided into two groups - with genotypes II and ID (group 1) and DD (group 2). Patients of group 1 compared with those of group 2 had significantly lower end systolic and diastolic volumes and left ventricular myocardial mass index (by 45,7, 81,6 and 31,2%, respectively) and higher ejection fraction and percentage of fractional shortening (%ΔS) (by 35,3 and 35,7%, respectively). Perindopril exerted most pronounced hemodynamic effect in patients of group 2: after 1 month of therapy end systolic and end diastolic volumes decreased by 8,7 and 14,8%, respectively (p<0,05) while ejection fraction and %ΔS increased by 18,3 and 19,8%, respectively (p<0,05). This effect was sustained during further follow-up. Changes of parameters of diastolic function by the end of therapy were similar in both groups.