Editorial Aldosterone Antagonists and Chronic Aortic Regurgitation: Promising But Not Quite Ready for Prime Time

The medical management of asymptomatic patients with chronic aortic valve regurgitation (AR) remains controversial. Clinical trials evaluating the power of vasodilators such as nifedipine or angiotensin-converting enzyme inhibitors (ACEIs) to slow the development of volume-overload cardiomyopathy or the occurrence of heart failure in patients with this valvular disease have yielded conflicting results (1-3). Chronic volume overload, such as that seen in severe AR, causes progressive dilatation and hypertrophy of the left ventricle. In parallel with this remodeling, the left ventricular (LV) function eventually decreases, symptoms appear, and valve replacement surgery often becomes necessary.

A recent clinical trial failed to confirm any positive effects of nifedipine or enalapril treatment compared to placebo (4). Consequently, when considering these conflicting data, the AHA/ACC Valvular Heart Disease Treatment Guidelines no longer recommend any vasodilator for the medical management of chronic AR in patients with a normal ventricular function (5).
Human clinical trials focusing on AR are unfortunately rare, and usually include a limited number of patients with many confounding factors and pitfalls (6). The use of an animal model of a disease can help to overcome some of these pitfalls, and offers the added benefit of providing cardiac tissues for analysis.