Early Enalapril Therapy on Long-Term Mortality in Patients with Asymptomatic Left Ventricular Systolic Dysfunction: A 22-Year Follow-Up of SOLVD in Belgium

Abstract

In the Studies of Left Ventricular Dysfunction (SOLVD), enalapril therapy did not reduce mortality in patients with left ventricular systolic dysfunction but without clinical heart failure. We reported here the 22-year mortality outcomes of such patients previously enrolled in SOLVD in Belgium. Among the 398 Belgian patients originally enrolled in the SOLVD Prevention Trial, post-trial mortality data were prospectively collected on all 336 survivors (165 in enalapril vs. 171 in placebo group) at trial closeout. All patients were placed on enalapril after the trial ended. Use of enalapril was classified as either “early” if started in trial or “delayed” if started post trial. The median delay in therapy was 3.3 years. No patients were lost to follow-up. The median duration of follow-up was 21.7 years from the time of randomization or 18.9 years from the time of closeout. The overall 5-, 10-, 15-, and 20-year cumulative survival rates were 74%, 50%, 32%, and 20% respectively. All-cause Kaplan-Meier mortality did not differ over the entire follow-up period between patients who received early as compared to delayed enalapril therapy (82% vs. 87%, p=0.12) but differed significantly over the post-trial period in favor of patients who received early therapy (78% vs. 88%, p=0.007). Early therapy was associated with a significant 24% risk reduction in all-cause mortality over the post-trial period (95% CI 3-40%, p=0.03). This corresponded to a significant increase in life expectancy of 34.1 months (95% CI 4.6-73.5 months) among patients who were treated early as compared to late (p=0.02). Post-trial use of ACE inhibitors (78%) was similar between the two groups. In an extended follow-up of SOLVD, early therapy with enalapril improved late survival in patients with asymptomatic left ventricular systolic dysfunction.