Captopril mediated decrease of aortic regurgitation.

Reske, S. N.; Heck, I.; Kropp, J.; Mattern, H.; Ledda, Roberta Eufrasia; Knopp, Reinhold; Winkler, C.

doi:10.1136/hrt.54.4.415

Cited by 29 publications

(10 citation statements)

References 12 publications

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“…(Circulation 1988;78:92-103) P revious studies have shown that vasodilator drugs acutely reduce the regurgitant volume and improve cardiac performance in aortic insufficiency. [1][2][3][4][5][6][7] Consequently, vasodilator therapy has emerged as an important modality for the shortterm management of patients with this lesion. These findings also raise the possibility that long-term therapy may chronically reduce the volume overload to the left ventricle.…”

mentioning

confidence: 99%

Long-term vasodilator therapy of chronic aortic insufficiency. A randomized double-blinded, placebo-controlled clinical trial.

et al. 1988

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Although vasodilator drugs acutely reduce regurgitation and improve cardiac performance in aortic insufficiency, their long-term effects on left ventricular size and function are uncertain. Consequently, we performed a double-blinded, placebo-controlled trial using hydralazine in 80 minimally symptomatic patients who had clinically stable, moderate-to-severe aortic insufficiency. Patients randomized to hydralazine displayed a progressive reduction in left ventricular end-diastolic volume index (LVEDVI) measured by radionuclide angiography, the predetermined end point of the study. At 24 months, mean LVEDVI had been reduced by 30 38 ml/m2, an 18% reduction from baseline. In contrast, LVEDVI changed minimally in patients randomized to placebo, and the intergroup differences over time were statistically significant (p<0.03). The hydralazine group also experienced reductions in left ventricular end-systolic volume index and increases in ejection fraction that were significantly different (both p<0.01) from changes in placebo-treated patients. These findings show that long-term treatment with hydralazine reduces the volume overload in aortic insufficiency and suggest that such therapy may have a beneficial effect on the natural history of the disease. (Circulation 1988;78:92-103) P revious studies have shown that vasodilator drugs acutely reduce the regurgitant volume and improve cardiac performance in aortic insufficiency. 1-7 Consequently, vasodilator therapy has emerged as an important modality for the shortterm management of patients with this lesion. These findings also raise the possibility that long-term therapy may chronically reduce the volume overload to the left ventricle. maintain cardiac performance in or close to the normal range." However, prolonged volume overload often leads to deterioration in left ventricular performance so that later in the course, signs and symptoms of cardiac dysfunction frequently develop.8,'0 An intriguing prospect is that the prophylactic administration of a vasodilator drug during the stable plateau phase of volume overload might be able to reduce either the extent of left ventricular dilation or its progression. The present study was undertaken to test the hypothesis that long-term vasodilator therapy with oral hydralazine reduces the volume overload and, hence, the left ventricular end-diastolic volume in clinically stable, moderate-to-severe aortic insufficiency. It was conducted as a prospective, randomized, placebocontrolled, double-blinded trial with change in left ventricular volume measured by radionuclide angiography as the predetermined end point.

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mentioning

confidence: 99%

Long-term vasodilator therapy of chronic aortic insufficiency. A randomized double-blinded, placebo-controlled clinical trial.

et al. 1988

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“…In experimental severe AR, ACEIs improved myocardial metabolism and survival in association with reduction of LV hypertrophy and other structural changes 57 . In patients with chronic AR, ACEI diminished regurgitant volume 49 . Also, in a 12 month randomized double blind trial of asymptomatic patients with non-rheumatic mild to moderate AR, LV end diastolic and systolic volumes and mass indices improved with enalapril compared with hydralazine 58 .…”

Section: Vasodilatorsmentioning

confidence: 94%

Drug Therapy for Heart Valve Diseases

Borer

Sharma

2015

Circulation

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Valvular heart diseases (VHDs) are progressive. When not caused by acute comorbidities they are generally characterized by long asymptomatic phases during which hemodynamic severity may progress leading to morbidity and mortality. Treatment depends on VHD type and severity but when severe and symptomatic, usually involves mechanical intervention. Asymptomatic patients, and those who lack objective descriptors associated with high risk, are closely observed clinically with optimization of associated cardiovascular risk factors until surgical indications develop. Though often prescribed based on theory, no rigorous evidence supports pharmacological therapy in most chronic situations though drugs may be appropriate in acute valvular diseases, or as a bridge to surgery in severely decompensated patients. Herein, we examine evidence supporting drug use for chronic VHDs.

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“…Several studies reported a reduction in aortic regurgitant volume with acute therapy [5,[15][16][17][18], but others only showed beneficial effects on LV dimensions, hypertrophy, and function (Table 1) [6][7][8].…”

Section: Aortic Regurgitationmentioning

confidence: 99%

Role of vasodilators in regurgitant valve disease

Evangelista

Tornos²,

Sambola³

et al. 2006

Curr Treat Options Cardio Med

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Vasodilator therapy is designed to reduce regurgitant volume and improve left ventricular function. Acute administration reduces vascular resistance and decreases regurgitant volume and left ventricular filling pressure. These effects may be clinically useful in acute regurgitations, but less consistent results have been reported in long-term therapy. In chronic mitral functional regurgitation, vasodilator therapy has proved to have clinical or prognostic benefit only when heart failure or poor ventricular function is present. The indication of vasodilator treatment in aortic regurgitation has raised significant controversy. Several studies with small series have shown beneficial effects on regurgitant volume, ejection fraction, and mass of the left ventricle. Nevertheless, in the only two randomized long-term follow-up studies, results differed completely. In our experience, both nifedipine and enalapril failed to reduce the need for valvular surgery or show benefits in echocardiographic parameters. Vasodilator therapy would be indicated only in patients with severe aortic regurgitation and systemic hypertension, or when surgery is contraindicated.

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Captopril mediated decrease of aortic regurgitation.

Cited by 29 publications

References 12 publications

Long-term vasodilator therapy of chronic aortic insufficiency. A randomized double-blinded, placebo-controlled clinical trial.

Long-term vasodilator therapy of chronic aortic insufficiency. A randomized double-blinded, placebo-controlled clinical trial.

Drug Therapy for Heart Valve Diseases

Role of vasodilators in regurgitant valve disease

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