Effects of perindopril on cardiac remodelling and prognostic value of pre-discharge quantitative echocardiographic parameters in elderly patients after acute myocardial infarction : the PREAMI echo sub-study

Aims To determine (i) the effect of perindopril on several geometric and functional parameters of the left and right ventricles assessed by echocardiography in the unique Perindopril and Remodelling in Elderly with Acute Myocardial Infarction (PREAMI) population of post-acute myocardial infarction (AMI) elderly patients with preserved left ventricular (LV) function; and (ii) the prognostic predictors at pre-discharge derived from echo-Doppler measurements in the same population. Methods and results PREAMI included 1252 post-AMI patients (age 73 +/- 6 years, LV ejection fraction 59.1 +/- 7.7%) receiving optimal therapy after AMI, randomized to perindopril 8 mg/day (n = 631) or placebo (n = 621); n = 896 had complete echo-Doppler data. Outcome measures were clinical [death, heart failure (HF)] and standard echo-Doppler parameters. Pre-discharge LV end-diastolic volume (LVEDV) was similar: 81.1 +/- 23.1 (perindopril) and 79.6 +/- 22.7 mL (placebo). At 6 months and 1 year, LVEDV remained unchanged with perindopril (81.2 +/- 24.4 and 81.8 +/- 26.8 mL, respectively), but increased with placebo (83.0 +/- 25.3 and 83.6 +/- 25.7 mL, respectively, both P < 0.001 vs. baseline). Perindopril reduced cardiac sphericity vs. placebo (P = 0.015 at 6 months; P = 0.020 at 1 year). Classification regression tree analysis showed treatment as the most important predictor of remodelling. Multiple pre-discharge echocardiographic variables predicted the death/HF endpoint, independently of treatment (P </= 0.05). Conclusion Remodelling occurs in post-AMI in elderly patients with normal LV function. Echo-Doppler variables at baseline have prognostic implications. Treatment with perindopril reduces progressive LV remodelling that can occur even in the case of small infarct size.