Treatment of chronic congestive heart failure

To the Editor: The Studies of Left Ventricular Dysfunction (SOLVD) investigators (Aug. 1 issue)¹ describe prognostic benefit from angiotensin-converting—enzyme inhibition in heart failure, confined largely to patients with severe compromise of left ventricular ejection fraction. Though there was a trend toward improvement in the combined end point of death or hospitalization in the group of patients with ejection fractions between 0.30 and 0.35, there was no trend toward improvement in mortality in this subgroup. The possible confinement of prognostic benefits from treatment with an angiotensin-converting—enzyme inhibitor to patients with more severe left ventricular dysfunction would have a major impact on.