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Captopril Reduces the VE/VCO2 Ratio in Myocardial Infarction Patients With Low Ejection Fraction FREE TO VIEW

Timothy R. McConnell; Francis J. Menapace, Jr.; L. Howard Hartley; Marc A. Pfeffer
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Affiliations: From the Department of Cardiology, Geisinger Medical Center, Danville, PA,  From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.

Timothy R. McConnell, PhD, Director, Cardiac Rehabilitation, Geisinger Medical Center, Danville, PA 17822-2160; e-mail: tmcconnell@psghs.edu

1998 by the American College of Chest Physicians

Chest. 1998;114(5):1289-1294. doi:10.1378/chest.114.5.1289
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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.




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