Captopril reduces the VE/VCO2 ratio in myocardial infarction patients with low ejection fraction.

Abstract

STUDY OBJECTIVES: To determine whether captopril (CAP) therapy had an effect on the minute ventilation/carbon dioxide output (VE/VCO2) ratio at submaximal levels of exercise in asymptomatic patients with reduced left ventricular function after myocardial infarction. DESIGN: Double blinded, randomized, prospective, repeated measures. PATIENTS AND INTERVENTIONS: One hundred thirty-five patients with left ventricular ejection fractions of < 40% were randomly assigned to a treatment group (CAP; n = 62) or a placebo group (PLC; n = 73). Subjects had cycle ergometer exercise tests at 2 to 6 months (T1), 10 to 14 months (T2), and > 22 months (T3) postmyocardial infarction. MEASUREMENTS: Oxygen uptake (VO2), VCO2, and VE were measured throughout each exercise test. Dependent variables were peak VO2 (VO2peak), the ventilatory anaerobic threshold (VAT), and the VE/VCO2 ratio measured at 30 W and at 75% VO2peak. RESULTS: VO2peak and VAT did not differ as a result of treatment (CAP vs PLC; p = 0.92 and 0.80) or over time (T1 vs T2 vs T3; p = 0.51 and 0.07). VE/VCO2 was significantly lower for CAP at 30 W (p = 0.05) and, although lower at 75% VO2peak, did not obtain statistical significance (p = 0.22). The between group differences were larger at T2 and T3 when compared with T1. CONCLUSIONS: CAP resulted in a reduced VE/VCO2 ratio during submaximal exercise. The reduced ventilation may permit patients to perform their normal activities of daily living at a lower perception of difficulty, reduce symptoms, and provide an improved quality of life.