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[Long-term captopril therapy in asymptomatic patients with severe chronic aortic insufficiency]
G Bisignani1, O Serafini, R Caporale
1Divisione di Cardiologia, Ospedale Civile dell'Annunziata, Cosenza.
Insights
Captopril therapy effectively reduced left ventricular size and mass in patients with severe chronic aortic regurgitation. This medical treatment may favorably alter the natural course of this condition.
Area of Science:
- Cardiology
- Pharmacology
- Echocardiography
Background:
- Severe chronic aortic regurgitation leads to progressive left ventricular enlargement.
- Oral vasodilators may delay ventricular dysfunction and the need for surgery.
- Understanding long-term treatment effects is crucial for managing this condition.
Purpose of the Study:
- To assess the long-term efficacy of captopril in reducing left ventricular mass and dimensions.
- To evaluate captopril's impact on hemodynamics in severe chronic aortic regurgitation.
- To determine if captopril can influence the progression of cardiac remodeling.
Main Methods:
- Prospective echocardiographic study with patients serving as their own controls.
- Eleven asymptomatic patients with severe chronic aortic regurgitation received captopril (127 +/- 13 mg/day) for 24 +/- 3 months.
- Ejection fraction, ventricular dimensions, myocardial mass, and wall stress were monitored.
Main Results:
- Significant reduction in left ventricular telediastolic diameter (69 to 61 mm) and telesystolic diameter (48 to 41 mm).
- Ejection fraction increased significantly (56% to 61%).
- Myocardial mass and mean wall stress decreased significantly, with effects sustained at 6 months.
Conclusions:
- Captopril demonstrates a favorable impact on left ventricular mass, dimensions, and load conditions.
- Medical management with captopril may positively influence the natural history of chronic aortic regurgitation.
- Serial echocardiography is effective for verifying the efficacy of medical treatments.
Background:
Clinical history of patients with severe chronic aortic regurgitation is characterized by a long period without any symptom, although the left ventricle enlarges progressively. The administration of oral vasodilators could reduce ventricular enlargement or its progression, delaying the development of myocardial dysfunction and/or the need for valvular surgery.
Objectives:
To verify the efficacy of long-term captopril therapy to reduce left ventricular mass and dimensions in patients with severe chronic aortic regurgitation.
Methods:
This is a prospective echocardiographic study in which each individual patient is considered his own control case. Eleven asymptomatic patients with severe chronic aortic regurgitation in sinus rhythm, who had an ejection fraction greater than 50% and were not taking cardiovascular drugs, were orally administered captopril at the maximum tolerated dosage (127 +/- 13 mg/day). Follow-up lasted for 24 +/- 3 months.
Results:
Left ventricular telediastolic diameter decreased from 69 +/- 5 to 61 +/- 3 mm (p < 0.01), telesystolic diameter decreased from 48 +/- 5 to 41 +/- 4 mm (p < 0.01); ejection fraction increased from 56 +/- 4 to 61 +/- 3% (p < 0.001); myocardial mass decreased from 208 +/- 32 to 174 +/- 27 g/m2 (p < 0.01), and mean wall stress from 264 +/- 35 to 203 +/- 25 mmHg (p < 0.001). All variations were still significant at 6 months.
Conclusions:
These results suggest that captopril has a favourable effect on left ventricular mass, dimensions and load conditions, and could favourably influence the natural history of chronic aortic regurgitation. The efficacy of medical treatment can be verified through serial echocardiographic study.