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Quinapril therapy in patients with chronic mitral regurgitation
H R Schön1, G Schröter, P Barthel
1Divisions of Cardiology and Nuclear Medicine, Technical University of Munich, Germany.
Insights
Long-term quinapril treatment significantly reduced mitral regurgitation and improved heart function in patients with chronic mitral regurgitation. This angiotensin-converting enzyme inhibitor therapy decreased left ventricular size and mass, potentially delaying the need for surgery.
Area of Science:
- Cardiology
- Pharmacology
- Medical Research
Background:
- Chronic mitral regurgitation (CMR) benefits from pre- and afterload reduction.
- Limited controlled studies exist on long-term angiotensin-converting enzyme inhibitor (ACEI) effects in CMR.
Purpose of the Study:
- To assess the one-year effects of quinapril (an ACEI) on myocardial performance in patients with CMR.
- To evaluate quinapril's impact on regurgitant fraction, left ventricular volumes, and mass.
Main Methods:
- Twelve patients with moderate-to-severe isolated CMR underwent echocardiography, right heart catheterization, and radionuclide ventriculography.
- Patients received quinapril (10-20mg/day) for one year, with assessments at baseline and follow-up.
- Measurements included regurgitant fraction, left ventricular volumes, ejection fraction, mass, and NYHA class.
Main Results:
- Quinapril significantly reduced regurgitant fraction (0.43 to 0.25, p=0.0001) and left ventricular end-diastolic volume (146 to 109 ml/m2, p=0.0001).
- Left ventricular end-systolic volume decreased (63 to 47 ml/m2, p=0.02), and left ventricular mass was reduced by 15% (p=0.0004).
- Left ventricular ejection fraction remained unchanged, but functional capacity improved by nearly one NYHA class.
Conclusions:
- One-year quinapril therapy effectively reduces regurgitation and left ventricular size/mass in CMR patients.
- ACEI treatment with quinapril demonstrates functional improvement and may delay the need for mitral valve surgery.
Abstract:
Pre- and afterload reduction is known to have beneficial effects in patients with chronic mitral regurgitation. To date, no controlled study has been reported analyzing the long term influence of angiotensin-converting enzyme inhibitor treatment on patients with chronic mitral regurgitation. Therefore the aim of this study was to assess the effects of one year angiotensin-converting enzyme inhibition with quinapril on myocardial performance in patients with chronic mitral regurgitation. Twelve patients with moderate to severe isolated chronic mitral regurgitation and no coronary disease on coronary angiography were studied under control conditions and followed up until one year of quinapril therapy (10-20mg/day) using echocardiography and simultaneous right heart catheterization, and radionuclide ventriculography at rest and exercise. As the result of a significant pre- and afterload reduction after one year quinapril treatment regurgitant fraction fell from 0.43 +/- 0.10 at control before therapy to 0.25 +/- 0.08 (p = 0.0001), left ventricular end-diastolic volume was reduced from 146 +/- 26 to 109 +/- 24 ml/m2 (p = 0.0001) and end-systolic volume decreased from 63 +/- 43 to 47 +/- 29 ml/m2 (p = 0.02). Left ventricular ejection fraction at control averaged 0.59 +/- 0.20 at rest, increased to 0.65 +/- 0.21 with maximum exercise and was unchanged after one year quinapril therapy. After one year treatment left ventricular mass was reduced by 15% (p = 0.0004) and septal wall thickness decreased from 11.8 +/- 0.7 to 10.8 +/- 0.8 mm (p = 0.0006). Moreover, there was significant functional improvement of nearly one NYHA class after one year quinapril therapy. In conclusion, in patients with chronic mitral regurgitation long term angiotensin-converting enzyme inhibition with quinapril reduces regurgitation and decreases left ventricular size and mass thereby demonstrating functional improvement. In addition, these data suggest that angiotensin-converting enzyme inhibition might have the potential of delaying mitral valve surgery.