© 2005 European Society of Cardiology
Effect of angiotensin-converting enzyme inhibition on functional class in patients with left ventricular systolic dysfunction—a meta-analysis
a Department of Cardiology P Gentofte University Hospital, Copenhagen, Denmark
b Population Health Research Institute and Division of Cardiology McMaster University and Hamilton Health Sciences, Hamilton, Canada
c National Institute of Public Health Copenhagen, Denmark
d Rigshospitalet Heart Centre, Department of Medicine Division of Cardiology, Copenhagen, Denmark
e Department of Internal Medicine Bispebjerg University Hospital, Copenhagen, Denmark
f Cardiovascular Division Brigham and Women's Hospital, Boston, MA, USA
g Department of Cardiology Bispebjerg University Hospital, Copenhagen, Denmark
* Correspondent author. Lyøvej 18, 3TV, DK-2000 Copenhagen F. Tel.: +45 39773977 926 (work), +45 38113340 (home); fax: +45 39760107. ja{at}heart.dk
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Abstract |
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Background: The effect of angiotensin converting enzyme (ACE) inhibitors on symptoms in patients with left ventricular systolic dysfunction (LVSD) is controversial.
Aims: To perform a meta-analysis of studies evaluating effect of ACE inhibitors on New York Heart Association (NYHA) class in patients with LVSD.
Methods: Individual data from 10389 patients in NYHA classes I–IV from four large long-term studies (2–4-year follow-up) and summary data from 2302 patients in NYHA classes II–IV from 16 short-term studies (3 months follow-up) were meta-analysed to assess changes in NYHA class.
Results: The large long-term studies showed a significant improvement in the worst NYHA classes (classes II–IV compared to class I) in the ACE inhibitor arm versus placebo, odds ratio (OR)=0.875 (0.811–0.943) p=0.0005. This effect was only present in studies which included patients with chronic heart failure and was particularly pronounced on deterioration to the worst NYHA class IV, OR=0.66 (0.52–0.84) p=0.001. There was no effect in the studies which included patients after myocardial infarction. The short-term chronic heart failure studies showed a significant improvement in NYHA class; OR for improvement of at least one NYHA class was 2.11 (1.48–2.98, 95% CI) p<0.0001.
Conclusion: ACE inhibition significantly improves symptomatic status measured as NYHA classification in patients with chronic heart failure.
Key Words: Angiotensin converting enzyme inhibitor • Congestive heart failure • Left ventricular dysfunction • Dyspnoea
Received September 23, 2004; Accepted March 3, 2005
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