ramipril and Mitral-Valve-Insufficiency

To evaluate the clinical efficacy and safety of pimobendan by comparing it with ramipril over a six-month period in dogs with mild to moderate heart failure (HF) caused by myxomatous mitral valve disease (MMVD).. This was a prospective randomised, single-blind, parallel-group trial. Client-owned dogs (n = 43) with mild to moderate HF caused by MMVD were randomly assigned to one of two groups, which received either pimobendan (P dogs) or ramipril (R dogs) for six months. The outcome measures studied were: adverse HF outcome, defined as failure to complete the trial as a direct consequence of HF; maximum furosemide dose (mg/kg/day) administered during the study period; and any requirement for additional visits to the clinic as a direct consequence of HF.. Treatment with pimobendan was well tolerated compared with treatment with ramipril. P dogs were 25 per cent as likely as R dogs to have an adverse HF outcome (odds ratio 4.09, 95 per cent confidence interval 1.03 to 16.3, P = 0.046).. R dogs had a higher overall score and thus may have had more advanced disease than P dogs at baseline (P = 0.04). These results should be interpreted cautiously but such a high odds ratio warrants further investigation.

Topics: Animals; Cardiotonic Agents; Dog Diseases; Dogs; Electrocardiography; Heart Failure; Mitral Valve; Mitral Valve Insufficiency; Odds Ratio; Prospective Studies; Pyridazines; Ramipril; Safety; Single-Blind Method; Treatment Outcome

Ramipril 10 mg/day reduced regurgitation in chronic mitral regurgitation secondary to mitral valve prolapse in patients with sinus rhythm.

Topics: Adult; Aged; Angiotensin-Converting Enzyme Inhibitors; Chordae Tendineae; Cross-Over Studies; Female; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Prolapse; Ramipril; Rupture; Ventricular Function, Left

Flail mitral valve usually causes severe mitral regurgitation, which may lead to left ventricular dysfunction if left uncorrected. The authors present a case of flail posterior mitral valve leaflet and severe mitral regurgitation in which mitral valve adaptation led to enlargement of the anterior mitral valve leaflet, decrease in mitral regurgitation, and reverse left ventricular remodeling without any need for surgery.

Topics: Adult; Antihypertensive Agents; Benzimidazoles; Biphenyl Compounds; Echocardiography; Echocardiography, Doppler, Color; Follow-Up Studies; Hemodynamics; Humans; Male; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Prolapse; Ramipril; Remission, Spontaneous; Tetrazoles; Ventricular Remodeling

Numerous agents have been associated with minimal change disease. We describe a previously unreported association in a 45-year-old white woman of scuba diving exposure to fire coral (Millepora species) that was followed by the development of nephrotic syndrome, acute renal failure, pulmonary edema, and intubation. The renal biopsy specimen was consistent with minimal change disease. Institution of corticosteroid therapy resulted in symptomatic improvement and resolution of proteinuria. Physicians, particularly those in scuba-diving areas, should consider minimal change disease in exposed patients with proteinuria because a prompt diagnostic and therapeutic approach may potentially limit complications.

Topics: Acute Kidney Injury; Animals; Anthozoa; Barbados; Bites and Stings; Combined Modality Therapy; Diving; Edema; Female; Forearm Injuries; Furosemide; Humans; Hydralazine; Intubation, Intratracheal; Labetalol; Marine Toxins; Middle Aged; Mitral Valve Insufficiency; Nephrosis, Lipoid; Nephrotic Syndrome; Prednisone; Pulmonary Edema; Ramipril

The objectives of this article are to determine the possible mechanism of functional mitral regurgitation in patients with dilated cardiomyopathy (DCM) and to know the effect of ramipril on left ventricle (LV) and mitral regurgitation by ECHO. Several postulates are put forth for functional mitral regurgitation in DCM, and mitral annular dilatation is said to be the primary mechanism in the past, but the exact mechanism is not clear. Though angiotensin converting enzyme (ACE) inhibitors are known to remodel the LV, their beneficial effect in patients with DCM with functional mitral regurgitation is not known. Various cardiac dimensions and degree of mitral regurgitation were measured by echocardiography in 30 normal control group and in 30 patients with DCM of various etiologies except ischemic, before and after ramipril therapy. There was a significant difference in all parameters especially sphericity of left ventricle and position of papillary muscles (P < 0.0003) in DCM patients, but mitral valve annulus did not show significant change (P < 0.3) compared to control group. In 50% of the patients, the functional mitral regurgitation totally disappeared. In 30% of patients, it came down from grade II to I or became trivial. In 20% of patients, it remained unchanged. There was remarkable improvement in sphericity, LV dimension, volumes, and EF%, which increased from 31 +/- 9.81 to 39.3 +/- 8.3% (P < 0.0003). It is concluded that echocardiography clearly demonstrates the increased sphericity of LV in DCM. The lateral migration of papillary muscles possibly plays a major role in functional mitral regurgitation. Ramipril significantly reduces not only sphericity but also functional mitral regurgitation.

Topics: Adolescent; Adult; Aged; Angiotensin-Converting Enzyme Inhibitors; Cardiomyopathy, Dilated; Case-Control Studies; Child; Echocardiography, Doppler, Color; Female; Follow-Up Studies; Heart Function Tests; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Probability; Prospective Studies; Ramipril; Reference Values; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Stroke Volume; Treatment Outcome; Ventricular Function, Left

Mitral regurgitation (MR) is a progressive disorder that leads to left ventricular (LV) dilatation and dysfunction. Previous small studies have shown conflicting results regarding the benefits of afterload reduction for MR.. We assessed by serial echocardiography the effects of ramipril on MR severity and LV size by a number of quantitative methods in 26 asymptomatic patients with moderate to severe MR at baseline and again after 6 months of ramipril treatment. We also evaluated exercise capacity, neurohormonal levels, and the Minnesota Living With Heart Failure score.. Despite a significant reduction in blood pressure with ramipril, there was no change in MR severity. MR severity, as assessed by effective regurgitant orifice area, was reduced in individuals with baseline systolic blood pressure (SBP) > or = 140 mm Hg (55.1 +/- 26 vs 37.4 +/- 35.4 mm2, P = .03), but not in individuals with SBP < 140 mm Hg (39.7 +/- 37.7 vs 46.1 +/- 34.1 mm2, P = not significant). Neither LV cavity size, exercise capacity, nor the Minnesota Living With Heart Failure score exhibited a significant change.. Patients with MR do not experience significant changes in MR severity, LV size, or functional status after 6 months of treatment with angiotensin-converting enzyme inhibition. However, patients with SBP > or = 140 mm Hg represent a subgroup that shows reduction in MR. These data are consistent with current American College of Cardiology/American Heart Association guidelines, which reserve the use of afterload reduction for MR patients with systemic hypertension or LV dysfunction.

Topics: Angiotensin-Converting Enzyme Inhibitors; Female; Heart Ventricles; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Ramipril; Severity of Illness Index; Ventricular Function