Six month pilot study of captopril for mildly symptomatic, severe isolated mitral and isolated aortic regurgitation

Long term therapy with vasodilating drugs has been shown to reduce left ventricular size and improve performance in chronic aortic regurgitation (AR). Similar trials in mitral regurgitation (MR) have not been published, nor has the effect of medium or long term therapy with angiotensin-converting enzyme (ACE) inhibitors been examined in either of these regurgitant lesions. Such therapy, if demonstrated to be effective in reducing left ventricular end-systolic size, might be anticipated to delay the need for valve replacement in asymptomatic patients. Medium term studies of the effects of ACE inhibitors on left ventricular size in regurgitant disease would therefore be helpful in designing long term trials to assess their impact on the timing of surgery. Patients with severe isolated MR (n = 32) or isolated AR (n = 23) and mild or no symptoms received either placebo or captopril 25 mg three times daily in a randomized, double blind, six month pilot study of left ventricular size using echocardiography. Treatment was well tolerated with no reported side effects. In MR, there were no significant immediate or 6-month effects of treatment on left ventricular diameter at end-systole (mean change at six months vs. baseline = +1% vs. +3% in placebo, p = 0.58 between groups) or end-diastole (+3% vs. 0% for placebo, p = 0.33). Nor was ejection fraction computed from radionuclide angiography effected by 6-month treatment (0.00 units vs. -0.01 units change in placebo).(ABSTRACT TRUNCATED AT 250 WORDS)