Document Detail


Nifedipine in asymptomatic patients with severe aortic regurgitation and normal left ventricular function.
MedLine Citation:
PMID:  8058074     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
R Scognamiglio; S H Rahimtoola; G Fasoli; S Nistri; S Dalla Volta
Related Documents :
20665054 - Efficacy of amiodarone on refractory ventricular fibrillation resistant to lidocaine an...
15176634 - Occlusion of a coronary ostium by an ingrowing endocardial vegetation: a case report.
7944804 - Surgical treatment of left ventricular outflow obstruction in the neonate: profound hyp...
11182784 - Echocardiographic evaluation of valvular stenosis: the gold standard for the next mille...
2661444 - Clinical experience with a new pulsatile pump for infant and pediatric cardiopulmonary ...
19519354 - Deciphering dual antiplatelet therapy in the era of drug-eluting coronary stents.
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    
Affiliation:
Department of Internal Medicine, University of Padua Medical School, Italy.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adult
Aortic Valve Insufficiency / drug therapy*,  physiopathology*,  surgery
Chronic Disease
Digoxin / adverse effects,  therapeutic use
Female
Follow-Up Studies
Heart Valve Prosthesis
Humans
Male
Nifedipine / adverse effects,  therapeutic use*
Stroke Volume
Ventricular Function, Left / physiology*
Chemical
Reg. No./Substance:
20830-75-5/Digoxin; 21829-25-4/Nifedipine
Comments/Corrections
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 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Developmental expression of mouse steroidogenic factor-1, an essential regulator of the steroid hydr...
Next Document:  Prenatal diagnosis of congenital toxoplasmosis with a polymerase-chain-reaction test on amniotic flu...