Favorable effects of vasodilators on left ventricular remodeling in asymptomatic patients with chronic moderate-severe aortic regurgitation and normal ejection fraction: a meta-analysis of clinical trials.
BACKGROUND
The role of vasodilator therapy in asymptomatic patients with chronic moderate to severe aortic regurgitation (AR) and normal left ventricular (LV) function is uncertain. We assessed the effects of vasodilator therapy (hydralazine, calcium channel blockers, and angiotensin-converting enzyme inhibitors) in this subgroup of patient population.


OBJECTIVE
Vasodilators have favorable effects on LV remodelling in asymptomatic patients with chronic moderate to severe aortic regurgitation and normal LV function.


METHODS
We performed a systematic literature search for randomized clinical trials using long-term vasodilator therapy in asymptomatic patients with chronic severe AR and normal LV function. The magnitude of difference between the vasodilator and nonvasodilator groups was assessed by computing the mean difference (MD). Heterogeneity of the studies was analyzed by Cochran Q statistics. The MD for LV ejection fraction, LV end systolic volume index, and LV end diastolic volume index were computed by random effects model. The MD for LV end-systolic diameter and LV end-diastolic diameter were computed by fixed effects model. A 2-sided alpha error <0.05 was considered to be statistically significant.


RESULTS
Seven studies with 460 patients were included. Meta-analysis of the studies revealed a significant increase in LVEF (MD: 5.32, 95% confidence interval [CI]: 0.37 to 10.26, P = 0.035), a significant decrease in LV end diastolic volume index (MD: -16.282, 95% CI: -23.684 to -8.881, P < 0.001), and a significant decrease in LV end diastolic diameter (MD: -2.343, 95% CI: -3.397 to -1.288, P < 0.001) in the vasodilator group compared with the nonvasodilator group. However, there was no significant decrease in LV end systolic volume index (MD: -6.105, 95% CI: -12.478 to 0.267, P = 0.060) or in LV end systolic diameter (MD: 0.00, 95% CI: -0.986 to 0.986, P = 1.0) in the vasodilator group compared with the nonvasodilator group.


CONCLUSIONS
In asymptomatic patients with chronic severe AR and normal LV function, vasodilators have favorable effects on LV remodeling.
Department of Cardiology/Internal Medicine, Rosalind Franklin University/Chicago Medical School, Chicago, Illinois, USA. dr_rachit@yahoo.com
Rachit M
RM
Shah
Mukesh
M
Singh
Rohit
R
Bhuriya
Janos
J
Molnar
Rohit R
RR
Arora
Sandeep
S
Khosla
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001022:Aortic Valve Insufficiency / Q000188:drug therapy* / Q000473:pathology; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D016001:Confidence Intervals; D018450:Disease Progression; D006352:Heart Ventricles / Q000187:drug effects*; D006801:Humans; D006830:Hydralazine / Q000627:therapeutic use; D013223:Statistics as Topic; D013318:Stroke Volume; D014665:Vasodilator Agents / Q000627:therapeutic use*; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling / Q000187:drug effects*
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D014665:Vasodilator Agents; D006830:Hydralazine