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Previous Volume 353:1342-1349 September 29, 2005 Number 13 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Carabello, B. A. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Vasodilator therapy can reduce the left ventricular volume and mass and improve left ventricular performance in patients with aortic regurgitation. Accordingly, it has been suggested that such therapy may reduce or delay the need for aortic-valve replacement.

Methods We randomly assigned 95 patients with asymptomatic severe aortic regurgitation and normal left ventricular function to receive open-label nifedipine (20 mg every 12 hours), open-label enalapril (20 mg per day), or no treatment (control group) to identify the possible beneficial effects of vasodilator therapy on left ventricular function and the need for aortic-valve replacement.

Results After a mean of seven years of follow-up, the rate of aortic-valve replacement was similar among the groups: 39 percent in the control group, 50 percent in the enalapril group, and 41 percent in the nifedipine group (P=0.62). In addition, there were no significant differences among the groups in aortic regurgitant volume, left ventricular size, left ventricular mass, mean wall stress, or ejection fraction. One year after valve replacement, the left ventricular end-diastolic diameter and end-systolic diameter had decreased to a similar degree among the patients who underwent surgery in each of the three groups, and all the patients had a normal ejection fraction.

Conclusions Long-term vasodilator therapy with nifedipine or enalapril did not reduce or delay the need for aortic-valve replacement in patients with asymptomatic severe aortic regurgitation and normal left ventricular systolic function. Furthermore, such therapy did not reduce the aortic regurgitant volume, decrease the size of the left ventricle, or improve left ventricular function.

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.

Full Text of this Article

Related Letters:

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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