Background Vasodilator therapy can reduce the left ventricularvolume and mass and improve left ventricular performance inpatients with aortic regurgitation. Accordingly, it has beensuggested that such therapy may reduce or delay the need foraortic-valve replacement.
Methods We randomly assigned 95 patients with asymptomatic severeaortic regurgitation and normal left ventricular function toreceive open-label nifedipine (20 mg every 12 hours), open-labelenalapril (20 mg per day), or no treatment (control group) toidentify the possible beneficial effects of vasodilator therapyon left ventricular function and the need for aortic-valve replacement.
Results After a mean of seven years of follow-up, the rate ofaortic-valve replacement was similar among the groups: 39 percentin the control group, 50 percent in the enalapril group, and41 percent in the nifedipine group (P=0.62). In addition, therewere no significant differences among the groups in aortic regurgitantvolume, left ventricular size, left ventricular mass, mean wallstress, or ejection fraction. One year after valve replacement,the left ventricular end-diastolic diameter and end-systolicdiameter had decreased to a similar degree among the patientswho underwent surgery in each of the three groups, and all thepatients had a normal ejection fraction.
Conclusions Long-term vasodilator therapy with nifedipine orenalapril did not reduce or delay the need for aortic-valvereplacement in patients with asymptomatic severe aortic regurgitationand normal left ventricular systolic function. Furthermore,such therapy did not reduce the aortic regurgitant volume, decreasethe size of the left ventricle, or improve left ventricularfunction.
Source Information
From the Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona.
Address reprint requests to Dr. Evangelista at the Servei de Cardiologia, Hospital Universitari Vall d'Hebron, P. Vall d'Hebron 119-129, 08035 Barcelona, Spain or at aevangel{at}vhebron.net.
Vasodilators in Aortic Regurgitation
Takagi H., Umemoto T., Krasuski R. A., Griffin B. P., Afshinnia F., Rahimtoola S. H., Evangelista A., Tornos P., Permanyer-Miralda G.
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N Engl J Med 2006;
354:300-303, Jan 19, 2006.
Correspondence
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