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Effects of stopping long-term vasodilator therapy in patients with chronic aortic insufficiency
D Nauman1, B Greenberg, B Massie
1Department of Medicine, Oregon Health Sciences University, Portland.
Insights
Stopping long-term vasodilator therapy in patients with chronic stable aortic insufficiency did not cause clinical deterioration. Left ventricular size returned to baseline, suggesting discontinuation is safe for these patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic stable aortic insufficiency often requires long-term medical management.
- Vasodilator therapy, such as hydralazine, has been used to manage left ventricular volumes in these patients.
- The long-term effects and safety of discontinuing vasodilator therapy are not well-established.
Purpose of the Study:
- To investigate the clinical and hemodynamic effects of discontinuing long-term vasodilator therapy in patients with chronic stable aortic insufficiency.
- To assess the safety and impact on disease progression after stopping hydralazine treatment.
Main Methods:
- A cohort of 17 patients with chronic stable aortic insufficiency on long-term hydralazine therapy was studied.
- Patients underwent clinical follow-up and serial radionuclide evaluations before and after stopping hydralazine.
- Left ventricular volumes and clinical status were monitored for approximately 20 months after drug discontinuation.
Main Results:
- No patient experienced acute clinical deterioration upon stopping vasodilator therapy.
- Left ventricular size returned to baseline levels after discontinuing hydralazine.
- The rate of progression to valve replacement did not significantly differ from historical controls.
Conclusions:
- Long-term vasodilator therapy can be safely discontinued in patients with chronic stable aortic insufficiency.
- Discontinuation does not lead to clinical deterioration or significantly alter the progression to valve replacement.
- This finding supports a potential reassessment of vasodilator use in stable aortic insufficiency.
Abstract:
We studied the effects of stopping long-term vasodilator therapy in 17 patients with chronic stable aortic insufficiency. These patients received hydralazine for 37 +/- 15 months (mean +/- SD) and, as a result, had experienced a significant decrease in left ventricular volumes. All patients were followed clinically and ten of the patients underwent serial radionuclide evaluation at baseline, while receiving drug, and at 20 +/- 7 months after stopping drug therapy. No patient showed evidence of acute clinical deterioration when drug therapy was stopped. The rate of progression to valve replacement due to onset of symptoms or left ventricular dysfunction was not significantly different from that previously reported in a population with similar characteristics. Left ventricular size, however, returned to levels similar to baseline after drug therapy was stopped. We conclude that long-term vasodilator therapy may be discontinued in patients with chronic stable aortic insufficiency without causing clinical deterioration or significant alteration in rate of progression to valve replacement.