© 2004 European Society of Cardiology
A meta-analysis of the effect of angiotensin-converting enzyme inhibitors on functional capacity in patients with symptomatic left ventricular systolic dysfunction
a Department of Cardiology P, Gentofte University Hospital Niels Andersensvej 65, DK-2990 Hellerup, Denmark
b National Institute of Public Health Denmark
c Department of Medicine I, Bispebjerg University Hospital Denmark
d Rigshospitalet Heart Centre, Department of Medicine Division of Cardiology B, Denmark
e Department of Cardiology Y, Bispebjerg University Hospital Copenhagen, Denmark
* Correspondent author. Tel.: +45-38113340; Fax: +45-39760107 E-mail address: jawab{at}dadlnet.dk
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Abstract |
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Aim: To determine by meta-analysis whether angiotensin-converting enzyme (ACE) inhibitors improve exercise tolerance in patients with symptomatic left ventricular systolic dysfunction (LVSD).
Methods and results: After literature search 13 multi-centre double blind parallel group trials that evaluated the effect of ACE inhibitors vs. placebo on exercise duration were selected. Ninety-four percent of patients were in New York Heart Association class II–IV. The studies were combined using the Cochrane meta-analysis program (Review manager version 4.1). Analyses according to treatment period, exercise protocols and publication periods were performed. Treatment with ACE inhibitor over 4–12 weeks resulted in a beneficial effect on exercise duration (P=0.003 and P=0.0008 for 4- and 12-weeks treatment, respectively), but the magnitude of improvements did not exceed 30 s corresponding to only 5% compared with placebo.
Conclusion: In addition to the pronounced effect on mortality and morbidity in patients with symptomatic LVSD, ACE inhibitors have improving effect on functional capacity measured as exercise tolerance time.
Key Words: Angiotensin-converting enzyme inhibitor • Congestive heart failure • Exercise tolerance • Exercise capacity • Clinical trial
Received June 11, 2003; Revised November 7, 2003; Accepted February 5, 2004
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