Document Detail

Nifedipine in asymptomatic patients with severe aortic regurgitation and normal left ventricular function.
MedLine Citation:
PMID:  8058074     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Vasodilator therapy with nifedipine reduces left ventricular volume and mass and increases the ejection fraction in asymptomatic patients with severe aortic regurgitation. METHODS: To assess whether vasodilator therapy reduces or delays the need for valve replacement, we randomly assigned 143 asymptomatic patients with isolated, severe aortic regurgitation and normal left ventricular systolic function to receive either nifedipine (20 mg twice daily, 69 patients) or digoxin (0.25 mg daily, 74 patients). RESULTS: By actuarial analysis, we determined that after six years a mean (+/- SD) of 34 +/- 6 percent of the patients in the digoxin group had undergone valve replacement, as compared with only 15 +/- 3 percent of those in the nifedipine group (P < 0.001). In the digoxin group, valve replacement (in a total of 20 patients) was performed because of left ventricular dysfunction (ejection fraction < 50 percent) in 75 percent, left ventricular dysfunction plus symptoms in 10 percent, and symptoms alone in 15 percent. In the nifedipine group, all six patients who underwent valve replacement did so because of the development of left ventricular dysfunction. In addition, all the patients in both groups who underwent aortic-valve replacement had an increase of 15 percent or more in the left ventricular end-diastolic volume index. After aortic-valve replacement, 12 of the 16 patients (75 percent) in the digoxin group and all six patients in the nifedipine group who had had an abnormal left ventricular ejection fraction before surgery had a normal ejection fraction. CONCLUSIONS: Long-term vasodilator therapy with nifedipine reduces or delays the need for aortic-valve replacement in asymptomatic patients with severe aortic regurgitation and normal left ventricular systolic function.
R Scognamiglio; S H Rahimtoola; G Fasoli; S Nistri; S Dalla Volta
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The New England journal of medicine     Volume:  331     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1994 Sep 
Date Detail:
Created Date:  1994-09-15     Completed Date:  1994-09-15     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  689-94     Citation Subset:  AIM; IM    
Department of Internal Medicine, University of Padua Medical School, Italy.
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MeSH Terms
Aortic Valve Insufficiency / drug therapy*,  physiopathology*,  surgery
Chronic Disease
Digoxin / adverse effects,  therapeutic use
Follow-Up Studies
Heart Valve Prosthesis
Nifedipine / adverse effects,  therapeutic use*
Stroke Volume
Ventricular Function, Left / physiology*
Reg. No./Substance:
20830-75-5/Digoxin; 21829-25-4/Nifedipine
Comment In:
ACP J Club. 1995 Jan-Feb;122(1):A12-3   [PMID:  7704477 ]
N Engl J Med. 2006 Jan 19;354(3):300-3; author reply 300-3   [PMID:  16422022 ]
N Engl J Med. 2006 Jan 19;354(3):300-3; author reply 300-3   [PMID:  16422021 ]
N Engl J Med. 1994 Sep 15;331(11):736-7   [PMID:  8058081 ]
N Engl J Med. 1995 May 11;332(19):1302-3; author reply 1303-4   [PMID:  7772147 ]
N Engl J Med. 1995 May 11;332(19):1303; author reply 1303-4   [PMID:  7708080 ]
N Engl J Med. 1995 May 11;332(19):1303; author reply 1303-4   [PMID:  7708081 ]

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