title: Mildly symptomatic chronic mitral regurgitation. Analysis of left ventricular systolic function and mitral regurgitation fraction under pharmacological influence. Echocardiographic study.
abstract: OBJECTIVE
  To study echocardiographic parameters of left ventricular systolic function and valvar regurgitation under pharmacological influence in mildly symptomatic patients with chronic mitral regurgitation (MR).
  
  
  METHODS
  We carried out a double-blind placebo controlled study in 12 patients with MR, mean aged 12.5 years old, who were randomized in 4 phases: A) digoxin; B) enalapril; C) digoxin + enalapril; D) placebo. The medication was administered for 30 days in each phase, and the following variables were analyzed: shortening and ejection fractions, wall stress index of left ventricle, left ventricular meridional end-systolic wall stress, Doppler-derived mean rate of left ventricular pressure rise (mean dP/dt), stroke volume and MR jet area. The clinical variables analysed were heart rate and systemic arterial pressure.
  
  
  RESULTS
  No significant variation was observed in the clinical variables analysed. The shortening and ejection fraction, the mean dP/dt and stroke volume significantly increased and the wall stress index of left ventricle, the meridional left ventricular end systolic wall stress and the mitral regurgitation jet area decreased in the phases with medication as compared with that in the placebo phase.
  
  
  CONCLUSIONS
  The parameters of left ventricular systolic function improved significantly and the degree of MR decreased with the isolated administration of digoxin or enalapril in mildly symptomatic patients with chronic MR. The combination of the drugs, however, did not show better results.
authors.affiliation: Escola Paulista de Medicina, UNIFESP, São Paulo, SP, Brazil. irrivera@uol.com.br
authors.forename: Ivan Romero
authors.initials: IR
authors.lastname: Rivera
authors.forename: Valdir Ambrósio
authors.initials: VA
authors.lastname: Moisés
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: Carvalho
authors.forename: Angelo Amato V
authors.initials: AA
authors.lastname: de Paola
mesh_terms: D000293:Adolescent; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D002648:Child; D002908:Chronic Disease; D004077:Digoxin / Q000627:therapeutic use; D004311:Double-Blind Method; D004656:Enalapril / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D013599:Systole; D013997:Time Factors; D014463:Ultrasonography; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D004656:Enalapril; D004077:Digoxin