Mechanism of reduction of mitral regurgitation with vasodilator therapy

Yoran, Chaim; Yellin, Edward L.; Becker, Ronald M.; Gabbay, Shlomo; Frater, Robert W.M.; Sonnenblick, Edmund H.

doi:10.1016/0002-9149(79)90077-8

Cited by 149 publications

(25 citation statements)

References 18 publications

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“…Nitroprusside increases forward output not only by preferentially increasing aortic flow but also by partially restoring MV competence as LV size diminishes. 535,536 In the patient rendered hypotensive because of a severe reduction in forward output, nitroprusside should not be administered alone, but combination therapy with an inotropic agent (such as dobutamine) and nitroprusside is of benefit in some patients. In such patients, aortic balloon counterpulsation increases forward output and mean arterial pressure while diminishing regurgitant volume and LV filling pressure and can be used to stabilize the patient while they are prepared for surgery.…”

Section: Medical Therapymentioning

confidence: 99%

“…535 If LV systolic dysfunction is present, primary treatment of the LV systolic dysfunction with drugs such as ACE inhibitors or beta blockers (particularly carvedilol) and biventricular pacing have all been shown to reduce the severity of functional MR. 560 -563 In patients with MR who develop symptoms but have preserved LV function, surgery is the most appropriate therapy. If atrial fibrillation develops, heart rate should be controlled with rate-lowering calcium channel blockers, beta blockers, digoxin, or, rarely, amiodarone.…”

Section: Medical Therapymentioning

confidence: 99%

See 1 more Smart Citation

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Bonow¹,

Carabello²,

Chatterjee³

et al. 2008

Circulation

916

259

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Section: Medical Therapymentioning

confidence: 99%

Section: Medical Therapymentioning

confidence: 99%

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Bonow¹,

Carabello²,

Chatterjee³

et al. 2008

Circulation

916

259

View full text Add to dashboard Cite

“…3 Therefore, clinicians have long been interested in finding nonsurgical therapies for chronic MR. Traditional drugs for the treatment of congestive heart failure, including vasodilators 4,5 and angiotensin-converting enzyme inhibitors, have been tested. 6 Although these medications may have acute favorable hemodynamic effects in MR, they have not shown promising results in limited long-term studies.…”

Section: Editorial See P 624 Clinical Perspective On P 762mentioning

confidence: 99%

Effects of Early, Late, and Long-term Nonselective β-Blockade on Left Ventricular Remodeling, Function, and Survival in Chronic Organic Mitral Regurgitation

Gao

et al. 2013

Circ: Heart Failure

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Background-Mitral regurgitation (MR) produces sympathetic nervous system activation which is detrimental in other causes of heart failure. However, whether β-blockade is beneficial in MR has not been determined. Methods and Results-Eighty-seven rats with significant organic MR were randomized to the β-blockade group (n=43) or the control group (n=44). Carvedilol was started in week 2 post MR induction and given for 23 to 35 weeks in the β-blockade group. Echocardiography was performed at baseline and at weeks 2, 6, 12, 24, 30, and 36 after MR induction. After 23 weeks of β-blockade, heart rates were significantly reduced by carvedilol (308±25 versus 351±31 beats per minute; P<0.001). Left ventricular end-diastolic (2.2±0.7 versus 1.59±0.6 mL; P<0.001), end-systolic volumes (0.72±0.42 versus 0.40±0.19 mL; P<0.001), and mass index (2.40±0.55 versus 2.06±0.62 g/kg; P<0.001) were significantly higher, and left ventricular fraction shortening (33±7% versus 38±7%; P<0.001) and ejection fraction (69±11% versus 75±7%; P<0.001) were significantly lower in the β-blockade group than in the control group. Systolic blood pressure was lower in the β-blockade group than in the control group (114±10 versus 93±12 mm Hg; P<0.005). Survival probability was significantly lower in the early β-blockade group than in the control group (88% versus 96%; P=0.03). 14 This dissociation creates a possible pathophysiological contradiction because adverse LV remolding is often associated with LV dysfunction and poor long-term outcome in all forms of congestive heart failure. Therefore, it is important to determine whether beneficial effects of β-blockade could be demonstrated if chronic organic MR was treated in the early stages before the development of LV dysfunction and if treatment is long-term. It is also imperative to determine whether LV remodeling associated with β-blocker therapy could ultimately have a negative impact on LV function in chronic organic MR or if the early improvement in LV function and myocardial contractility observed in prior studies could lead to improvement in LV remodeling if treatment was initiated early and long-term. To clarify this important issue, we performed a prospective study to determine the effects of early, late, and long-term β-blockade on LV remodeling, systolic function, and survival in experimental chronic MR. The study design had the following unique characteristics: (1) the study used a unique rat model of chronic MR developed in our laboratory, 15 allowing us to use a large numbers of animals to test the hypothesis; (2) carvedilol (a nonselective β-adrenergic blocking agent with α 1 -blocking activity) was administered early before the development of LV systolic dysfunction; and (3) a long-term treatment strategy was applied. Conclusions-Early Methods Rat Model of MRThe study protocol was approved by the Institution's Animal Care and Use Committee of the Pennsylvania State University College of Medicine (assurance number A3045-01). The study was performed according to the guidelines of the Amer...

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“…Reduction of left ventricular volume with increase in ejection fraction, changes in left ventricular geometry or diastolic wall properties, and changes in regional blood flow may also explain or contribute to the improvement in left ventricular function and clinical status of these patients (Brodie et al, 1977;Yoran et al, 1979), but these were not determined in the present study.…”

Section: -mentioning

confidence: 75%

“…Several investigators have recently demonstrated that agents that reduce left ventricular afterload have beneficial effects on left ventricular filling pressures, stroke volume, and cardiac output (Chatterjee et al, 1973;Goodman et al, 1974;Harshaw et al, 1975;Miller et al, 1976;Sniderman et al, 1974;Yoran et al, 1979). Most of these studies were done using parenteral or single-dose oral agents in acutely ill patients resting in a supine position.…”

Section: Introductionmentioning

confidence: 99%

Effects of oral hydralazine on rest and exercise hemodynamics in patients with aortic or mitral regurgitation and left ventricular dysfunction

Slosky

Hindman

Peter

et al. 1981

Clinical Cardiology

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Summary:The hemodynamic effects of afterload reduction were studied at rest and during two levels of upright exercise in patients with aortic or mitral regurgitation and left ventricular dysfunction. Eleven patients underwent invasive hemodynamic monitoring before and after 50-70 mg of oral hydralazine was given every 6 h for 48 h. At rest, heart rate and mean arterial pressure after hydralazine were unchanged from control. During exercise, there was no significant change in heart rate, but mean arterial pressure fell significantly during the first level of exercise. Systemic vascular resistance was elevated before hydralazine and was significantly reduced after treatment at both exercise levels. After hydralazine, the resting oxygen consumption was significantly elevated at rest but was unchanged during exercise, the arteriovenous oxygen difference was significantly narrowed at both rest and exercise, and the pulmonary capillary wedge pressure was also significantly lower at both rest and exercise. In this select group of patients who are not candidates for surgical valve replacement, chronic afterload reduction with oral hydralazine may result in increased cardiac performance, decreased pulmonary congestion, reduced myocardial oxygen demands, and improvement in resting and/or exertional symptoms.

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Mechanism of reduction of mitral regurgitation with vasodilator therapy

Cited by 149 publications

References 18 publications

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Effects of Early, Late, and Long-term Nonselective β-Blockade on Left Ventricular Remodeling, Function, and Survival in Chronic Organic Mitral Regurgitation

Effects of oral hydralazine on rest and exercise hemodynamics in patients with aortic or mitral regurgitation and left ventricular dysfunction

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