Vasodilation with felodipine in chronic asymptomatic aortic regurgitation

Abstract

Background Afterload reduction decreases volume overload on the left ventricle and may thereby delay the need for valve replacement in chronic asymptomatic aortic regurgitation. The aims of this randomized double-blind, placebo-controlled trial to were examine short- and long-term hemodynamic effects of felodipine in chronic asymptomatic aortic regurgitation. Methods Sixteen patients were randomly assigned to an intravenous infusion of either felodipine 0.3 mg or placebo followed by 3 months' treatment with felodipine 10 mg or placebo orally once daily. Magnetic resonance imaging was performed at baseline, immediately after intravenous treatment, and after 3 months of oral treatment. Results Intravenous felodipine caused a statistically significant reduction in the systemic vascular resistance from (mean ± SD) 1160 ± 400 to 970 ± 320 dynes · s · cm −5 ( P < .05), in the regurgitant volume index from 1.5 ± 0.8 to 1.3 ± 0.8 L · min −1. m −2 ( P < .05) and in the regurgitant fraction from 0.31 ± 0.15 to 0.26 ± 0.14 ( P < .05). The forward cardiac output index increased significant from 3.2 ± 0.9 to 3.5 ± 0.7 L · min −1 ·m −2 ( P < .05). Three months of oral treatment with felodipine caused a corresponding but more pronounced decrease in systemic vascular resistance of 880 ± 330 dynes · s · cm −5 ( P < .05), regurgitant volume index of 1.2 ± 0.7 L · min −1 · m −2 ( P < .05), and regurgitant fraction 0.25 ± 0.11 ( P < .05), whereas the forward cardiac output index increased to 3.6 ± 0.7 l · min −1 · m −2 ( P < .05). No significant changes were found in the placebo group. Left ventricular volumes and ejection fraction remained unaffected by treatment, but compared with the placebo group left ventricular myocardial mass decreased significantly from 137 ± 24 to 132 ± 21 g · m −2 ( P < .01). Conclusion In chronic asymptomatic aortic regurgitation, felodipine causes beneficial hemodynamic effects that may postpone the need for valve replacement.