The Effects of Enalapril on Survival in Patients with Reduced Left Ventricular Ejection Fractions and Congestive Heart failure (Treatment Trial) - SOLVD-Treatment


Enalapril vs. placebo for mortality in heart failure.


Enalapril will reduce mortality in patients with reduced left ventricular function and congestive heart failure when added to conventional therapy.

Study Design

Study Design:

Patients Screened: 39,924
Patients Enrolled: 2,569
NYHA Class: I=(11%), II=(57%),III=(30%), IV=(2%)
Mean Follow Up: 41 months
Mean Patient Age: 61
Female: 20
Mean Ejection Fraction: 25%

Patient Populations:

Patients with congestive heart failure and ejection fraction <35% already taking drugs other than ACE inhibitor for congestive heart failure.


Age >80
Valvular disease
Angina requiring revascularization or unstable characteristics
Recent myocardial infarction (<1 month)
Creatinine >2.0
Any other disease shortening survival
Significant carotid artery disease

Primary Endpoints:

all cause

Secondary Endpoints:

Combined endpoints of death/hospitalizations for congestive heart failure
Ejection fraction measured by radionuclide (68%)
Contrast angiography (11%)
Echocardiogram (21%)

Drug/Procedures Used:

Enalapril (2.5 to 20 mg/day)
Background treatment with digoxin/diuretics

Concomitant Medications:

Digoxin (67%)
Diuretics (85%)
K-sparing diuretics (9%)
Vasodilators (51%)
Antiarrhythmics (22%)
Beta blockers (7.5%)
Calcium channel blockers (31%)
Anticoagulants (16%)
Antiplatelets (33%)
Potassium supplementation (50%)

Principal Findings:

Enalapril group had 16% reduction in all cause mortality.
Death due to progressive heart failure reduced by 22% with Enalapril.
Combined endpoint of death or hospitalization for worsening congestive heart failure reduced by 26% with Enalapril.
All cardiovascular deaths below 18% in Enalapril group.
No effect on death due to arrhythmia worsening congestive heart failure.


Enalapril improves symptoms and decreases mortality in patients with mild to moderate symptomatic heart failure and left ventricular dysfunction when used with digoxin and diuretics.


1. N Engl J Med 1991;325:293-302. Final results
2. Am J Cardiol 1995;75:1244-9. Ventricular arrhythmia substudy
3. Am J Cardiol 1996;78:890-5. Quality of life

Keywords: Enalapril, Digoxin, Diuretics, Heart Failure, Ventricular Dysfunction, Left

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