Unloading effects of prazosin in patients with chronic aortic regurgitation

Seventeen patients with chronic aortic regurgitation (AR) were examined by echocardiography and left and right heart catheterization. Cardiac output and regurgitation volume were measured by the dye dilution method. Administration of single and four repeated doses of prazosin (PZ) led to reductions of left ventricular (LV) end-diastolic, end-systolic, and left atrial end-systolic diameters, and decrease of left ventricular filling pressure. Regurgitation fraction, regurgitation flow, and volume indexes decreased significantly (p less than 0.01). Total left ventricular output decreased (p less than 0.001) as did derived parameters of left ventricular work and performance. Fractional shortening, ejection fraction, and mean circumferential fiber shortening velocity increased as did LV dP/dt and dP/dt/P. Changes in heart rate and cardiac and stroke indexes after PZ were not significant. Preload reduction (dilation of the venous bed and reduction of regurgitation) seems to be the most important effect of PZ in AR. We found PZ to be a suitable and effective drug for oral treatment of chronic AR.