Relation of indirect vasodilator use to prognosis in patients with chronic severe mitral regurgitation.
OBJECTIVE
The relation of indirect vasodilator use to cardiac events (CE) is undefined for chronic severe nonischemic mitral regurgitation (MR). The aim of this study was to resolve this knowledge deficiency.


METHODS
Data from 52 consecutive patients in our prospective natural history study with isolated chronic severe nonischemic MR were assessed post hoc over 19 years to examine the relation of indirect vasodilator use to subsequent CE (death or indications for valve surgery). At entry, no patient had surgical indications, 14% had hypertension (HTN) and 7 chronically received vasodilators (5 angiotensin-converting enzyme inhibitor, 1 receptor blocker and 1 α-adrenergic blocker). CE differences were assessed by log-rank comparison of Kaplan-Meier curves.


RESULTS
During follow-up, CE included sudden death (1 patient), heart failure (7 patients), atrial fibrillation (6 patients), left ventricular (LV) systolic dimension >4.5 cm (12 patients), LV ejection fraction (EF) <60% (7 patients), right ventricular EF <35% (2 patients) and combination CE (7 patients). Overall, vasodilator use did not predict CE (not significant). However, patients without HTN had higher CE rates with vasodilators than without (p = 0.007), while those with HTN and vasodilators had lower CE rates than those without vasodilators (p = 0.04).


CONCLUSIONS
Vasodilator use appears to confer no survival benefit in patients with chronic severe MR. The small number of patients with HTN precludes conclusions about modulation of vasodilator effect by HTN. Randomized trials are needed to conclusively evaluate this association.
Howard Gilman Institute for Valvular Heart Diseases, State University of New York (SUNY) Downstate Medical Center, Brooklyn, N.Y., USA.
Phyllis G
PG
Supino
Nasimullah
N
Khan
Ofek
O
Hai
Edmund M
EM
Herrold
Clare
C
Hochreiter
Jeffrey S
JS
Borer
D001281:Atrial Fibrillation / Q000517:prevention & control; D002908:Chronic Disease; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D005500:Follow-Up Studies; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents