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Beneficial long-term effects of hydralazine in aortic regurgitation
J G Dumesnil1, K Tran, G R Dagenais
1Québec Heart Institute, Department of Medicine, Laval University, Sainte-Foy, Canada.
Insights
Long-term vasodilator therapy, specifically hydralazine, may delay left ventricular dilatation in asymptomatic aortic regurgitation patients. This approach could potentially alter the disease
Area of Science:
- Cardiology
- Pharmacology
Background:
- Long-term effects of vasodilators in asymptomatic aortic regurgitation are understudied.
- Aortic regurgitation can lead to progressive left ventricular dilatation.
Purpose of the Study:
- To investigate the long-term effects of vasodilators on left ventricular dimensions in asymptomatic patients with significant aortic regurgitation.
Main Methods:
- Retrospective review of echocardiograms from 19 asymptomatic patients with aortic regurgitation.
- Patients were followed up annually for up to 4 years.
- Comparison between patients receiving hydralazine hydrochloride and those not receiving vasodilators.
Main Results:
- Non-vasodilator group showed progressive left ventricular dilatation (8% diastolic, 13% systolic after 3 years).
- Hydralazine group experienced a decrease in left ventricular dimensions (-7% diastolic, -7% systolic) in the first year of treatment.
- Some patients showed increased dimensions beyond the first year of hydralazine therapy.
Conclusions:
- Long-term vasodilator therapy may delay left ventricular dilatation progression in asymptomatic aortic regurgitation.
- Hydralazine hydrochloride might influence the natural history of the disease.
- Vasodilator therapy could potentially delay the need for surgical intervention.
Abstract:
The long-term effects of vasodilators in asymptomatic patients with aortic regurgitation have not been studied extensively. We retrospectively reviewed the echocardiograms of 19 asymptomatic patients with significant aortic regurgitation followed up annually for up to 4 years (average +/- SD, 3.1 +/- 0.7 years). Of these 19 patients, 12 were not receiving vasodilators and 7 were receiving hydralazine hydrochloride, 40 to 200 mg daily. In the patients not receiving vasodilators, left ventricular diastolic and systolic dimensions increased progressively in all patients by an average of 8% and 13%, respectively, after 3 years. In the patients receiving hydralazine, left ventricular dimensions increased by 9% and 5% in the year or more before hydralazine use and decreased by 7% and 7%, respectively, during the first year after using hydralazine. The reduction was observed in all patients during the first year, but an increase was detected in 3 patients followed up beyond that period. The results suggest that the progression of left ventricular dilatation in asymptomatic patients with aortic regurgitation can be delayed by long-term therapy with vasodilators. Pending further confirmation, such therapy may possibly influence the natural history of the disease and delay the timing of operation.