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Long-term treatment with ACE-inhibitors improves left ventricular function in patients with aortic regurgitation. But how does this advantage influence capacity? Using echocardiography and spiroergometry, we investigated 13 patients before and after a 3 month treatment with cilazapril (2.5-5 mg/d). Ventricular enddiastolic diameter-index decreased from 3.5 to 3.1 cm/m2 (p = 0.005), left ventricular endsystolic diameter-index from 2.3 to 2.0 cm/m2 (p = 0.005), and wallstress from 174 to 150 dyn/cm2 (p = 0.01). Left ventricular mass was reduced by 14% to 488 g (= 253 g/m2, p < 0.05). The regurgitant jet area decreased from 10.1 to 8.1 cm2 (p < 0.05). Wall thickness, workload, and maximal oxygen intake showed no significant difference during follow-up. These results indicate that left ventricular volumes and muscle mass in patients with aortic regurgitation are positively influenced by long term ACE-inhibition, which preserves exercise capacity.

To evaluate the usefulness of cine-MRI for the quantitative assessment of aortic valve regurgitation, 31 patients (54 +/- 15 years of age; 22 M, 9 F) and 10 normal volunteers underwent a multi-modality imaging protocol comparing cine-MRI with color Doppler echocardiography and contrast aortography. Twenty-one patients had aortic regurgitation with an associated transvalvular gradient, 10 patients had pure valve incompetence. Aortic insufficiency as assessed by the signal void from regurgitant flow on cine-MRI was best analyzed on transversal tomograms. Both the volume of the signal void caused by turbulence above a threshold velocity, and the ratio of the diameters of the regurgitant jet and the outflow tract (dAL-Jet/DLVOT) were found to correlate closely with the (Seller's) angiographic regurgitant score by r = 0.86 each (p < 0.001), and the color Doppler echocardiographic index by r = 0.74 and 0.89, respectively (p < 0.001). Cine-MRI failed to differentiate the angiographic grades I and II, however, clearly separated grades II, III, and IV in contrast to other non-invasive imaging modalities. Moreover, a semiquantitative index derived from cine-MRI allowed a rapid assessment of the severity of regurgitation, similar to color Doppler echocardiography and the semiquantitative angiographic Seller's score. Thus, cine-MRI volumetric evaluation of transvalvular flow turbulences provides a useful and reproducible means to quantify aortic regurgitation. It also allows serial atraumatic investigations as a diagnostic alternative to color Doppler examination in patients less suitable for echocardiographic evaluation and may prove helpful in monitoring the natural course of aortic valve disease.

The beneficial effect of Nitroglycerin (NTG) on myocardial oxygen-supply-demand ratio in severe aortic stenosis has been already demonstrated. But the chronic administration of isosorbide dinitrate (ISDN) does not reduce the increase in left ventricular filling pressures during exercise. Therefore in severe aortic stenosis, the effects of chronic nitrate administration on left ventricular hemodynamics during exercise do not correspond to the beneficial acute effects of NTG. In aortic insufficiency, sublingual NTG has only minor effects on left ventricular volumes, heart rate and cardiac output. A moderate reduction in pressures results in a significant reduction of wall stress, while there is no major change in regurgitant fraction.

Data of 417 patients with advanced chronic aortic valve disease were retrospectively analyzed using a life table and Cox regression analysis. Aortic valve replacement was recommended to all patients based on clinical and hemodynamic findings. While most patients underwent prosthetic aortic valve replacement (n = 349), a minority of patients was treated medically (n = 68). Prognosis was better (p less than 0.01 in the Cox model) in surgically treated as compared to medically treated patients with aortic stenosis (4-year survival rate 82 versus 44%). In patients with aortic insufficiency no significant difference of long-term prognosis was found between surgically and medically treated patients.

The effect of muzolimine (initial dose 60 mg followed by 30 mg/day for 14 days) on 15 patients with aortic and mitral incompetence and chronic cardiac failure, functional class 3, was analyzed on the basis of repeated clinical observations, metabolic studies as well as mono and bidimensional echo changes 2, 24 hours and 15 days after the initial dose. An important variation was a reduction in body weight by 3-4% after the first day and by a further 1-2% after 2 weeks. No significant variations were observed regarding heart rate and blood pressure at rest. Plasma level of electrolytes as well as other important biochemical parameters in the serum (BUN, glucose and creatinine) were uninfluenced. A small increase was observed in both the plasma level of chloride and in the red cell count. Urine volume increased by two to threefold after the first day; this increase was still present after 2 weeks. Changes in the left ventricular end-diastolic and end-systolic volumes were not significant after the first day; however a slight but significant reduction was observed after 2 weeks and was in parallel with the improvement of the functional class of the patients. Data, in particular the possible mode of action of muzolimine after acute administration and after short-term therapy, are discussed.

In 16 patients with chronic aortic regurgitation, we studied the acute hormonal and hemodynamic effects of 12.5 to 25 mg captopril; in 12 patients the changes after a 4 to 8 week treatment period (mean 6.3 +/- 2 weeks; doses: 3 times 12.5 to 3 times 25 mg/day) were investigated. The following baseline variables were evaluated: the radionuclide left ventricular ejection fraction (EF) at rest and during exercise, left ventricular end-diastolic volume (EDV), regurgitant blood volume (RBV); and plasma renin activity (PRA). Repeated determinations of EF, EDV and RPA were carried out 90 minutes after application of the drug. In patients with chronic therapy, EF at rest and during exercise, EDV, RBV and PRA were reinvestigated at the end of the study. Acute administration of captopril was followed by an increase of EF (from 49 +/- 12 to 55 +/- 12%, p less than 0.001) and a slight decrease of EDV (from 389 +/- 160 to 376 +/- 146 ml, p less than 0.05). PRA significantly increased (from 1.6 to 3.1 ng/ml/h, p less than 0.05). Chronic therapy resulted in a moderate decrease of systolic and diastolic blood pressure (from 156/70 +/- 31/15 to 140/63 +/- 23/15 mm Hg, p less than 0.01). However, no significant changes were observed in EF at rest and during exercise (51 +/- 9 vs. 53 +/- 10% and 45 +/- 14 vs. 47 +/- 14%), EDV (433 +/- 179 vs. 422 +/- 179 ml) and RBV (136 +/- 81 vs. 129 +/- 77 ml). PRA was significantly increased (6.3 ng/ml/h, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)