Background Vasodilator therapy with nifedipine reduces leftventricular volume and mass and increases the ejection fractionin asymptomatic patients with severe aortic regurgitation.
Methods To assess whether vasodilator therapy reduces or delaysthe need for valve replacement, we randomly assigned 143 asymptomaticpatients with isolated, severe aortic regurgitation and normalleft ventricular systolic function to receive either nifedipine(20 mg twice daily, 69 patients) or digoxin (0.25 mg daily,74 patients).
Results By actuarial analysis, we determined that after sixyears a mean (±SD) of 34 ±6 percent of the patientsin the digoxin group had undergone valve replacement, as comparedwith only 15 ±3 percent of those in the nifedipine group(P<0.001). In the digoxin group, valve replacement (in atotal of 20 patients) was performed because of left ventriculardysfunction (ejection fraction <50 percent) in 75 percent,left ventricular dysfunction plus symptoms in 10 percent, andsymptoms alone in 15 percent. In the nifedipine group, all sixpatients who underwent valve replacement did so because of thedevelopment of left ventricular dysfunction. In addition, allthe patients in both groups who underwent aortic-valve replacementhad an increase of 15 percent or more in the left ventricularend-diastolic volume index. After aortic-valve replacement,12 of the 16 patients (75 percent) in the digoxin group andall six patients in the nifedipine group who had had an abnormalleft ventricular ejection fraction before surgery had a normalejection fraction.
Conclusions Long-term vasodilator therapy with nifedipine reducesor delays the need for aortic-valve replacement in asymptomaticpatients with severe aortic regurgitation and normal left ventricularsystolic function.
Source Information
From the Division of Cardiology, Department of Internal Medicine, University of Padua Medical School, Padua, Italy (R.S., G.F., S.N., S.D.V.), and the Griffith Center and Division of Cardiology, Los Angeles County-University of Southern California Medical Center, Los Angeles (S.H.R.).
Address reprint requests to Dr. Scognamiglio at the Cattedra di Cardiologia, Policlinico, Via Giustiniani, 2, 35100 Padova, Italy.
Nifedipine in Severe Aortic Regurgitation
Manyari D. E., Yunus A., Klein L. J., Reichert C. L.A., Arnold A. E.R., Coats A. J.S., Scognamiglio R., Rahimtoola S. H.
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N Engl J Med 1995;
332:1302-1304, May 11, 1995.
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