Long-term vasodilator therapy in patients with severe aortic regurgitation.
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.
Evangelista
Artur
A
Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain. aevangel@vhebron.net
Tornos
Pilar
P
Sambola
Antonia
A
Permanyer-Miralda
Gaietà
G
Soler-Soler
Jordi
J
D000206:Actuarial Analysis; D000328:Adult; D001022:Aortic Valve Insufficiency / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D001794:Blood Pressure / Q000187:drug effects; D004656:Enalapril / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000494:pharmacology / Q000627:therapeutic use*; D017211:Treatment Failure; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016277:Ventricular Function, Left / Q000187:drug effects
D014665:Vasodilator Agents; D004656:Enalapril; D009543:Nifedipine