Effects of combination treatment with perindopril and losartan on left ventricular remodeling and cardiac function in patients with myocardial infarction

AIM: Inhibiting the renin-angiotensin-aldosterone system prevents left ventricular (LV) remodeling after myocardial infarction (MI). This study was designed to assess the effects of a combination of perindopril and losartan on LV remodeling, cardiac function and serum procollagen type Ⅲ aminoterminal peptide (PⅢNP) levels in patients with acute MI.METHODS: Patients with anterior MI were divided into 3 groups: MI+perindopril, MI+losartan, and MI+perindopril+losartan. After successful intervention therapy, perindopril 2-4 mg/d or losartan potassium 25-50 mg/d or combination of the both were administered. All patients took aspirin, clopidogrel and statins, while some of the patients were treated with beta-blockers, nitrate and a platelet glycoprotein IIb/Ⅲa receptor antagonist. Three months later, LV dimensions and LV ejection fraction (LVEF) were measured by ultrasonography. Plasma brain natriuretic peptide (BNP), serum C-reactive protein (CRP) and PⅢNP levels were evaluated with ELISA or RIA.RESULTS: Baseline characteristics of the 3 groups were the same. All patients showed decreased CRP, increased BNP and PⅢNP levels, and LV dilation and dysfunction after treatment for three months. Compared with the 2 single therapy groups, patients in the combination group showed significantly lower CRP, BNP and PⅢNP levels, less LV dilation and higher LVEF. Serum PⅢNP level was positively correlated with CRP level and LV end-diastolic volume index(r=0.597 and r=0.543, respectively,both P<0.01), and negatively correlated with LVEF(r=-0.565, P<0.01).CONCLUSION: For patients with AMI, combination of perindopril and losartan significantly inhibited LV remodeling and improved LV function. Inhibition of myocardial interstitial fibrosis might be part of the mechanism.