Quinapril therapy in patients with chronic mitral regurgitation

Pre- and afterload reduction is known to have beneficial effects in patients with chronic mitral regurgitation. To date, no controlled study has been reported analyzing the long term influence of angiotensin-converting enzyme inhibitor treatment on patients with chronic mitral regurgitation. Therefore the aim of this study was to assess the effects of one year angiotensin-converting enzyme inhibition with quinapril on myocardial performance in patients with chronic mitral regurgitation. Twelve patients with moderate to severe isolated chronic mitral regurgitation and no coronary disease on coronary angiography were studied under control conditions and followed up until one year of quinapril therapy (10-20mg/day) using echocardiography and simultaneous right heart catheterization, and radionuclide ventriculography at rest and exercise. As the result of a significant pre- and afterload reduction after one year quinapril treatment regurgitant fraction fell from 0.43 ± 0.10 at control before therapy to 0.25 ± 0.08 (p=0.0001), left ventricular end-diastolic volume was reduced from 146 ± 26 to 109 ± 24 ml/m2 (p=0.0001) and endsystolic volume decreased from 63 ± 43 to 47 ± 29 ml/m² (p=0.02). Left ventricular ejection fraction at control averaged 0.59 ± 0.20 at rest, increased to 0.65 ± 0.21 with maximum exercise and was unchanged after one year quinapril therapy. After one year treatment left ventricular mass was reduced by 15% (p=0.0004) and septal wall thickness decreased from 11.8 ± 0.7 to 10.8 ± 0.8 mm (p=0.0006). Moreover, there was significant functional improvement of nearly one NYHA class after one year quinapril therapy. In conclusion, in patients with chronic mitral regurgitation long term angiotensin-converting enzyme inhibition with quinapril reduces regurgitation and decreases left ventricular size and mass thereby demonstrating functional improvement. In addition, these data suggest that angiotensin-converting enzyme inhibition might have the potential of delaying mitral valve surgery.