Document Detail


Afterload reduction may halt and beta-adrenergic blockade may worsen progression of left ventricular dysfunction in patients with chronic compensated mitral regurgitation: a retrospective cohort study.
MedLine Citation:
PMID:  17495269     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Severe chronic mitral regurgitation (MR) is associated with progressive left ventricular (LV) systolic dysfunction. Both afterload reduction and beta-adrenergic blockade have been suggested as methods for preventing LV dysfunction in asymptomatic patients with MR and normal LV function, who are therefore not yet candidates for surgical intervention. The objective of this study was to determine if afterload reduction reduces progression of LV dysfunction in patients with severe MR. The reports of echocardiographic studies performed 20 +/-14 months apart were compared in a retrospective cohort of 134 asymptomatic patients with moderate-severe chronic MR and baseline ejection fraction (LVEF) >50%. Groups were defined by exposure to any afterload-reducing drug: Group 0, no exposure; Group 1, exposure beginning after the first echocardiogram; and Group 2, drug exposure beginning before the baseline echocardiogram. The groups differed importantly only in treatment duration. In 72 patients not exposed to beta-adrenergic blockade, LVEF decreased by a relative -3.2% in Group 0, while Group 1 increased by 3.4% and Group 2 increased by 5.1%, p <0.01. Among 62 patients exposed to beta-adrenergic blockade, LVEF consistently worsened (Group 0, 4.8%; Group 1, -3.3%; Group 2, -1.7%; p = 0.71) compared to the 72 patients without beta-adrenergic blockade. In a multivariate model that included treatment duration and exposure to other medications, the beneficial effect of afterload reduction (p <0.03) and the deleterious effect of beta-adrenergic blockade (p < 0.02) were significant. Afterload reduction halted or reversed the progressive worsening of left ventricular function while beta-adrenergic blockade had a deleterious effect.
Authors:
Stacie H Oh; David G Meyers
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Angiology     Volume:  58     ISSN:  0003-3197     ISO Abbreviation:  Angiology     Publication Date:    2007 Apr-May
Date Detail:
Created Date:  2007-05-14     Completed Date:  2007-06-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0203706     Medline TA:  Angiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  196-202     Citation Subset:  IM    
Affiliation:
Division of Cardiovascular Diseases, Kansas University School of Medicine, Kansas City, KS 66160-7231, USA.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / pharmacology*
Aged
Analysis of Variance
Chi-Square Distribution
Chronic Disease
Disease Progression
Echocardiography
Female
Humans
Male
Mitral Valve Insufficiency / complications*,  physiopathology,  ultrasonography
Retrospective Studies
Statistics, Nonparametric
Ventricular Dysfunction, Left / etiology*,  physiopathology,  prevention & control*,  ultrasonography
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists

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