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Objectives: The aim of this study was to investigate the long-term effects of perindopril on left ventricular (LV) systolic and diastolic function in patients with stable coronary artery disease who had previously undergone coronary artery bypass graft., Methods: Thirteen patients (12 male and one female patient) were treated with perindopril 8 mg/day and 13 (nine male and four female patients) with placebo, and both groups underwent conventional and Doppler tissue echocardiography (DTE) at baseline and after 12, 24, 36 and 47 months. DTE was sampled at the four sites of the mitral annulus and peak velocity (pv) and the time-velocity integral (tvi) of systolic (S) and diastolic (E and A) waves were calculated., Results: During the 47 months of follow-up, ejection fraction significantly increased in the perindopril group from 58 +/- 10 to 69 +/- 6% (P < 0.01) without any significant change in LV volumes. LV shortening and relaxation, assessed by DTE, also significantly increased: Stvi from 1.57 +/- 0.18 to 1.95 +/- 0.19 cm (P < 0.01) and Etvi from 0.95 +/- 0.23 to 1.37 +/- 0.59 cm (P < 0.05). There were no changes in ejection fraction (64 +/- 6 vs. 65 +/- 8%; P = not significant) or S or E waves in the placebo group, but a significant increase in LV diastolic volume. Blood pressure remained unchanged in both groups., Conclusion: Our data suggest that perindopril improves both systolic and diastolic LV myocardial performance, a beneficial effect that may be due to the previously demonstrated biological, anti-ischemic and endothelium-dependent action of perindopril.