Søndergaard L, Aldershvile J, Hildebrandt P, Kelbaek H, Ståhlberg F, Thomsen C
Danish Research Center for Magnetic Resonance, Hvidovre Hospital, Copenhagen, Denmark.
Am Heart J. 2000 Apr;139(4):667-74. doi: 10.1016/s0002-8703(00)90046-2.
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 were to examine short- and long-term hemodynamic effects of felodipine in chronic asymptomatic aortic regurgitation.
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.
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 significantly 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).
In chronic asymptomatic aortic regurgitation, felodipine causes beneficial hemodynamic effects that may postpone the need for valve replacement.
降低后负荷可减少左心室的容量超负荷，从而可能延迟慢性无症状主动脉瓣反流患者进行瓣膜置换的必要性。这项随机双盲、安慰剂对照试验的目的是研究非洛地平在慢性无症状主动脉瓣反流中的短期和长期血流动力学效应。
16例患者被随机分配接受静脉输注非洛地平0.3mg或安慰剂，随后口服非洛地平10mg或安慰剂，每日1次，共治疗3个月。在基线、静脉治疗后即刻以及口服治疗3个月后进行磁共振成像检查。
静脉输注非洛地平使体循环血管阻力从（均值±标准差）1160±400降至970±320达因·秒·厘米⁻⁵（P<.05），反流容积指数从1.5±0.8降至1.3±0.8升·分钟⁻¹·米⁻²（P<.05），反流分数从0.31±0.15降至0.26±0.14（P<.05）。心输出量指数显著从3.2±0.9增至3.5±0.7升·分钟⁻¹·米⁻²（P<.05）。口服非洛地平3个月导致体循环血管阻力相应但更显著地降至880±330达因·秒·厘米⁻⁵（P<.05），反流容积指数降至1.2±0.7升·分钟⁻¹·米⁻²（P<.05），反流分数降至0.25±0.11（P<.05），而心输出量指数增至3.6±0.7升·分钟⁻¹·米⁻²（P<.05）。安慰剂组未发现显著变化。左心室容积和射血分数未受治疗影响，但与安慰剂组相比，左心室心肌质量从137±24显著降至132±21克·米⁻²（P<.01）。
在慢性无症状主动脉瓣反流中，非洛地平产生有益的血流动力学效应，可能推迟瓣膜置换的必要性。
