Circulation, Vol 78, 92-103, Copyright © 1988 by American Heart Association
B Greenberg, B Massie, JD Bristow, M Cheitlin, D Siemienczuk, N Topic, RA Wilson, J Szlachcic and D Thomas
Although vasodilator drugs acutely reduce regurgitation and improve cardiac
performance in aortic insufficiency, their long-term effects on left
ventricular size and function are uncertain. Consequently, we performed a
double-blinded, placebo-controlled trial using hydralazine in 80 minimally
symptomatic patients who had clinically stable, moderate-to-severe aortic
insufficiency. Patients randomized to hydralazine displayed a progressive
reduction in left ventricular end- diastolic volume index (LVEDVI) measured
by radionuclide angiography, the predetermined end point of the study. At
24 months, mean LVEDVI had been reduced by 30 +/- 38 ml/m2, an 18%
reduction from baseline. In contrast, LVEDVI changed minimally in patients
randomized to placebo, and the intergroup differences over time were
statistically significant (p less than 0.03). The hydralazine group also
experienced reductions in left ventricular end-systolic volume index and
increases in ejection fraction that were significantly different (both p
less than 0.01) from changes in placebo-treated patients. These findings
show that long-term treatment with hydralazine reduces the volume overload
in aortic insufficiency and suggest that such therapy may have a beneficial
effect on the natural history of the disease.
ARTICLES
Long-term vasodilator therapy of chronic aortic insufficiency. A randomized double-blinded, placebo-controlled clinical trial
Department of Medicine, Oregon Health Sciences University, Portland 97201.
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