AIMS: To study the effect of angiotensin-converting enzyme (ACE) inhibitor trandolapril on exercise tolerance time (ETT) and New York Heart Association (NYHA) classification in patients with reduced left ventricular systolic dysfunction (LVSD) after acute myocardial infarction (AMI). METHODS AND RESULTS: The TRAndolapril Cardiac Evaluation (TRACE) was a randomized controlled study designed to evaluate the effect of trandolapril on mortality in 1749 consecutive Danish patients with LVSD after AMI. NYHA class was recorded every 3 months in all patients. In a prospective sub-study, 254 patients underwent exercise tolerance tests at 1, 3 and 12 months. The two treatment arms showed equal improvement in NYHA class both in the entire and exclusively symptomatic population over 4 years of follow-up (P=ns). ETT increased equally in both treatment arms at 1, 3, 12 months (P=ns). A mean of 12mg/day of furosemide was spared in trandolapril arm (P=0.001). CONCLUSIONS: Trandolapril had a mild diuretic-sparing effect. These results emphasis the importance of explaining to patients that ACE inhibitors provide protection against death and hospitalisation for heart failure but do not have any significant effect upon symptoms.