Effect of Angiotensin-Converting Enzyme Inhibitors in Left Ventricular Dysfunction

Over 13,000 patients have been randomized in 35 long-term trials of the use of angiotensin-converting enzyme (ACE) inhibitors in patients with heart failure or left ventricular dysfunction. Overall, there is a clear reduction in mortality and hospitalizations for heart failure and myocardial infarction with a trend toward fewer sudden deaths. Furthermore, there is a significant reduction in myocardial infarction in three of the larger trials. These benefits have been demonstrated with several different agents and are consistently seen in various subgroups of patients defined by symptomatic status, etiology of left ventricular dysfunction, age, and gender. However, benefits were greatest among patients with the lowest ejection fraction. In conclusion, ACE inhibitors are of established value in patients with heart failure and/or left ventricular dysfunction.