Long-term treatment with trandolapril in patients with reduced left ventricular function soon after myocardial infarction significantly reduced the risk of overall mortality, mortality from cardiovascular causes, sudden death, and the development of severe heart failure. That mortality was reduced in a randomized study enrolling 25 percent of consecutive patients screened should encourage the selective use of ACE inhibition after myocardial infarction.

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Regional myocardial blood flow, myocardial microvascular blood content and tissue haematocrit were determined in mongrel dogs. In nine dogs the intramyocardial distribution volumes of 99Tcm-albumin and 125I-fibrinogen were examined. Tracer equilibration times of 5, 10 and 30 min were used. The 125I-fibrinogen distribution volume was significantly lower than the distribution volume of 99Tcm-albumin. The 125I-fibrinogen distribution volume was not found to change with time and was thus taken to be a measure of the plasma volume. In 10 dogs intramyocardial distribution of 51Cr-labelled red cells and 125I-fibrinogen was estimated and regional myocardial blood flow was measured by 15 microns 99Tcm-albumin spheres. Plasma and red cell volumes, interpreted as myocardial microvascular blood content, ranged from 3.66 to 4.93 cm3-100 g-1. The distribution volumes indicated gradients with higher endocardial and longitudinal microvascular blood content in the left ventricular free wall and the septum. The intramyocardial haematocrits calculated from the plasma and red cell volumes were uniformly 0.3 all over the heart and amounted to 0.75 of arterial haematocrit. The mean right ventricular blood flow of 46.80 cm3 . min-1 . 100 g-1 amounted to 0.6 of a mean left ventricular blood flow of 86.65 cm3 . min-1 . 100 g-1. Transmural and longitudinal gradients of regional myocardial blood flow within the ventricular wall were observed. The patterns of transmural and longitudinal gradients of regional blood flow and microvascular blood content implies higher flow rates through more or larger vessels indicating a greater endocardial and apical vascular conductance in the vicinity of the left ventricular cavity.

In order to perform risk stratification, 195 consecutive, unselected patients with acute myocardial infarction (AMI) underwent independent echocardiographic and clinical evaluation of their left ventricular function by means of the wall motion index (WMI) and Killip classification 5 days after AMI. The patients were prospectively allocated to a low, medium or high risk class depending on WMI alone, and the 1-year mortality in these classes was 2, 34 and 37%, respectively (p < 0.0001). The 1-year mortality of the patients in Killip class I, II, or III and IV was 6, 26 and 48%, respectively (p < 0.00001). The number of patients allocated to the low risk group by means of WMI was 87, and the number of patients in Killip class I was 86. Since these groups were not identical, a total of 103 patients, i.e. 53% of the study population, could be identified as low risk patients regarding 1-year mortality 5 days after AMI, when WMI and Killip classification were used in combination. We conclude that the combination of echocardiographic and clinical evaluation of left ventricular function after AMI provides a strong and yet very simple procedure to identify low risk patients, which could be easily implemented in the routine work of coronary care units.