Effect of Beta-Blocker Therapy on Survival in Patients With Severe Aortic Regurgitation

Sampat, Unnati; Varadarajan, Padmini; Turk, Rami; Kamath, Ashvin; Khandhar, Sumit; Pai, Ramdas G.

doi:10.1016/j.jacc.2009.02.077

Cited by 65 publications

(25 citation statements)

References 30 publications

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“…[2][3][4] Based on the hypothesis that the adrenergic system is overactivated early in the course of chronic AR even before heart failure occurs, we have previously evaluated the effects of ␤-blockade with metoprolol in an animal model of chronic AR and found that it improved LV function, reduced LV hypertrophy, and increased survival. 5,6 Recently, Sampat et al 7 reported beneficial effects of ␤-blockers in a retrospective study of 756 patients. The use of ␤-blockers in chronic AR nevertheless remains controversial, mostly because drug-induced bradycardia may prolong diastole and consequently augment regurgitant time and volume.…”

Section: Clinical Perspective On P 213mentioning

confidence: 99%

Usefulness of Carvedilol in the Treatment of Chronic Aortic Valve Regurgitation

Zendaoui

Lachance

Roussel

et al. 2011

Circ: Heart Failure

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Background-Aortic regurgitation (AR) is a chronic disease for which there is currently no approved medical treatment.We previously reported in an animal model that ␤-blockade with metoprolol exerted beneficial effects on left ventricular remodeling and survival. Despite the recent publication of promising human data, ␤-blockade in chronic AR remains controversial. More data are needed to support this potentially new treatment strategy. We hypothesized that carvedilol might be another safe treatment option in chronic AR, considering its combined ␤-blocking and ␣-blocking effects and proven efficacy in patients with established heart failure. Methods and Results-The effects of a 6-month treatment with carvedilol 30 mg/kg/d orally were evaluated in adult Wistar rats with severe AR. Sham-operated and untreated AR animals were used as controls. Carvedilol treatment resulted in less left ventricular hypertrophy and dilatation. Ejection fraction was improved and filling pressures were reduced by carvedilol. ␤1-Receptor expression was also improved as well as myocardial capillary density. Those beneficial effects were noted despite the presence of drug-induced bradycardia. Conclusions-Carvedilol exerted protective effects against volume-overload cardiomyopathy in this model of aortic valve regurgitation with preserved ejection fraction. These results suggest a protective class effect of ␤-blockers. Combined with the recent publication of promising human data, our findings support the need to carefully design a prospective study in humans to evaluate the effects of ␤-blockers in chronic aortic valve regurgitation. (Circ Heart Fail. 2011;4: 207-213.)

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Section: Clinical Perspective On P 213mentioning

confidence: 99%

Usefulness of Carvedilol in the Treatment of Chronic Aortic Valve Regurgitation

Zendaoui

Lachance

Roussel

et al. 2011

Circ: Heart Failure

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“…1,2 This study was approved by our institutional review board. Our echocardiographic database, which contains records from 1993 to 2007, was searched for patients with severe AR defined by a jet height to left ventricular (LV) outflow tract dimension ratio of Ն0.6 or a prominent holodiastolic flow reversal in the aortic arch or the abdominal aorta.…”

Section: Patient Populationmentioning

confidence: 99%

Prognostic Implications of Mitral Regurgitation in Patients With Severe Aortic Regurgitation

Pai

Varadarajan

2010

Circulation

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Background— Mitral regurgitation (MR) is common in those with severe aortic regurgitation (AR) and can predispose to atrial fibrillation, heart failure, and a need for mitral valve surgery during aortic valve replacement (AVR). However, little data exist as to its clinical and prognostic implications. Methods and Results— Search of our echocardiographic data base between 1993 and 2007 yielded 756 patients with severe AR. with comprehensive clinical data from chart review and mortality data from National Death Index. Mortality was analyzed as a function of MR severity. Effect of AVR and concomitant mitral valve repair were investigated. Patient characteristics were age, 61±17 years; female sex, 41%; and ejection fraction, 54±19%. MR grade ≥2+ was present in 343 (45%) patients: 2+ in 152 (20%), 3+ in 93 (12%), and 4+ in 98 (13%). There was a progressive decrease in survival with each grade of MR ( P <0.0001). Performance of AVR was associated with a better survival in those with 3 or 4+ MR ( P =0.02). In addition, concomitant mitral valve repair in these patients resulted in a better survival (hazard ratio, 0.29; P =0.02). Conclusions— MR is common in patients with severe AR, with 3 or 4+ MR occurring in a quarter of these patients. It is an independent predictor of reduced survival. Performance of AVR and concomitant mitral valve repair is associated with a better survival. Development of MR should serve as an indication for AVR even in asymptomatic patients.

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“…However, a recent study, albeit retrospective, demonstrated a potential survival benefit with β blockers in patients with severe AR39; these data need to be prospectively confirmed.…”

Section: Managementmentioning

confidence: 96%

Management of multiple valve disease

Unger

Rosenhek

Dedobbeleer

et al. 2010

Heart

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Multivalvular heart disease is not an uncommon situation, but the paucity of data for each specific situation does not allow the proposal of a standardised, evidence-based management strategy. This paper aims at reviewing the available evidence on the management of multivalvular disease, taking into account the interactions between different valve lesions, the diagnostic pitfalls and the strategies that should be considered in the presence of multiple valvular disease.

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Effect of Beta-Blocker Therapy on Survival in Patients With Severe Aortic Regurgitation

Abstract: This observational study strongly suggests that BB therapy is associated with a survival benefit in patients with severe AR.

Cited by 65 publications

References 30 publications

Usefulness of Carvedilol in the Treatment of Chronic Aortic Valve Regurgitation

Usefulness of Carvedilol in the Treatment of Chronic Aortic Valve Regurgitation

Prognostic Implications of Mitral Regurgitation in Patients With Severe Aortic Regurgitation

Management of multiple valve disease

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