Effects of 12 months quinapril therapy in asymptomatic patients with chronic aortic regurgitation

This study was performed to assess the effects of one year of ACE inhibition with quinapril on left ventricular performance and morphology in asymptomatic patients with chronic aortic regurgitation. Pre- and afterload reduction is known to have beneficial effects in patients with chronic aortic regurgitation. To date, no controlled study has been reported analyzing long term influence of ACE inhibitor treatment on asymptomatic patients with chronic aortic regurgitation. Twelve asymptomatic patients with isolated moderate to severe chronic aortic regurgitation, no coronary disease on coronary angiography and no previous vasodilator treatment were studied under control conditions and after three and 12 months of quinapril therapy (10-20 mg/day) using echocardiography and simultaneous right heart catheterization and radionuclide ventriculography at rest and during supine bicycle exercise. After one year quinapril therapy regurgitant fraction fell by 17% compared to control before therapy (p=0.001), left ventricular enddiastolic volume at rest was reduced from 150 ± 33 to 128 ± 30 ml/m² (p=0.0003) and endsystolic volume decreased from 55 ± 27 to 44 ± 28 ml/m² (p=0.0005). Left ventricular ejection fraction at rest averaged 0.64 ± 0.11 at control and increased after one year therapy to 0.67 ± 0.11 (p=0.05). With maximum exercise (100 W), ejection fraction failed to rise at control; after one year therapy with quinapril it increased to 0.70 ± 0.15 (p=0.019). Moreover, after one year quinapril therapy there was a significant reduction of 35% in left ventricular mass compared to control. Furthermore, septal wall thickness as a measure of LV hypertrophy could be normalized from 13.2 ± 0.9 to 10.6 ± 1.0 mm (p=0.016). It is concluded that the long term unloading action of quinapril is able to decrease left ventricular dilatation, hypertrophy and mass, thereby improving left ventricular function. The results further suggest that ACE inhibition may have the potential to delay timing for aortic valve replacement in asymptomatic patients with chronic aortic regurgitation.