Efficacy of Perindopril on Reverse Left Ventricular Remodeling and Clinical Outcomes in De Novo Patients with Acute Myocardial Infarction and Reduced Ejection Fraction

Abstract

Objective: To evaluate the therapeutic efficacy of perindopril on echocardiographic parameters of reverse remodeling,
functional status, and 1-year all-cause mortality in newly diagnosed (de novo) HFrEF patients following an index AMI. Methods:
A targeted clinical analysis was conducted on a cohort of newly diagnosed, treatment-naive (de novo) HFrEF patients (baseline
LVEF <40%) presenting with an acute myocardial infarction (n = 43) extracted from a retrospective database (2018 to 2025). All
patients received perindopril (titrated dynamically based on tolerability up to 10 mg daily) alongside comprehensive guideline
directed post-infarction care. Serial evaluations were completed at baseline (Visit 1), 3 months (Visit 2), and 6 months (Visit 3).
Results: Pharmacological therapy with perindopril demonstrated profound structural efficacy, driving a significant longitudinal
increase in left ventricular ejection fraction (LVEF) and a corresponding mechanical reduction in cardiac chamber dimensions.
Mean LVEF increased from 34.31+3.90% at baseline to 41.3 + 7.39%t by 6 months (p<0.001), with the primary structural
recovery achieved rapidly within the initial 3 months of drug titration (mean difference: plus, 5.72%, (p<0.001). This prominent
early mechanical response was strongly enhanced by the high plasticity of the treatment-naive (de novo) myocardium.
Concurrently, left ventricular end-diastolic size (LVEDD) and end-systolic size (LVESD) decreased significantly by 0.25 cm and
0.39 cm, respectively, by Visit 3. Perindopril effectively mitigated secondary pulmonary hypertension, demonstrating stable
renal tolerance and a predictable safety profile during aggressive titration. Conclusion: In de novo HFrEF patients post-AMI, the
early implementation of perindopril facilitates highly robust reverse structural remodeling and clinical functional recovery,
driving a substantial portion of patients into an improved ejection fraction phenotype.