Evangelista Artur, Tornos Pilar, Sambola Antonia, Permayer-Miralda Gaieta
Servei de Cardiología, Hospital Universitari Vall d'Hebron, P Vall d'Hebron 119, 08035 Barcelona.
Curr Treat Options Cardiovasc Med. 2006 Dec;8(6):428-34. doi: 10.1007/s11936-006-0030-x.
Vasodilator therapy is designed to reduce regurgitant volume and improve left ventricular function. Acute administration reduces vascular resistance and decreases regurgitant volume and left ventricular filling pressure. These effects may be clinically useful in acute regurgitations, but less consistent results have been reported in long-term therapy. In chronic mitral functional regurgitation, vasodilator therapy has proved to have clinical or prognostic benefit only when heart failure or poor ventricular function is present. The indication of vasodilator treatment in aortic regurgitation has raised significant controversy. Several studies with small series have shown beneficial effects on regurgitant volume, ejection fraction, and mass of the left ventricle. Nevertheless, in the only two randomized long-term follow-up studies, results differed completely. In our experience, both nifedipine and enalapril failed to reduce the need for valvular surgery or show benefits in echocardiographic parameters. Vasodilator therapy would be indicated only in patients with severe aortic regurgitation and systemic hypertension, or when surgery is contraindicated.
血管扩张剂疗法旨在减少反流容积并改善左心室功能。急性给药可降低血管阻力，减少反流容积和左心室充盈压。这些作用在急性反流中可能具有临床意义，但长期治疗的结果报道不太一致。在慢性二尖瓣功能性反流中，血管扩张剂疗法仅在出现心力衰竭或心室功能不良时才被证明具有临床或预后益处。血管扩张剂治疗主动脉反流的适应证引发了重大争议。几项小样本研究显示对反流容积、射血分数和左心室质量有有益作用。然而，在仅有的两项随机长期随访研究中，结果完全不同。根据我们的经验，硝苯地平和依那普利均未能减少瓣膜手术的需求或在超声心动图参数上显示出益处。血管扩张剂疗法仅适用于重度主动脉反流和系统性高血压患者，或手术禁忌的情况。
