ABSTRACT
BACKGROUND AND AIM OF THE STUDY: Chronic mitral regurgitation (MR) causes volume overload on the left ventricle and, if uncorrected, will over time lead to left ventricular remodeling and heart failure. The benefits of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) in primary MR are not well defined. METHODS: MEDLINE was searched for studies in which the effects of ACE inhibitors and ARBs on chronic MR had been examined. The inclusion criteria required the patient population to have chronic MR, a normal left ventricular ejection fraction, and to report a quantitative measure of the change in MR severity. Studies in which patients had secondary MR were excluded. RESULTS: Nineteen studies met the inclusion criteria (13 daily therapy, five single-dose, and one combined study). The pooled mean decrease in regurgitant fraction (RF) was 7.7% [95% CI 4.9, 10.6] and 9.3% [95% CI 3.4, 15.2] for studies in patients with daily therapy and single-dose therapy, respectively. Among studies which reported changes in regurgitant volume (RV), the pooled mean decrease was 7.9 ml [95% CI 1.4, 14.5]. For patients with mitral valve prolapse (MVP), the pooled mean reduction in RF was 8.1% [95% CI 4.3, 11.9] and in rheumatic disease it was 3.4% [95% CI 13.2 - 7.0]. Across the seven studies of daily therapy which reported a change in left ventricular end-diastolic volume index (LVEDVI), the mean decrease was 11.5 ml/m2 [95% CI 2.4, 20.6]. CONCLUSION: ACE inhibitors and ARBs each reduced the RF, RV, and left ventricular size by a modest degree in chronic primary MR.
Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Heart Failure/prevention & control , Heart Ventricles/drug effects , Hypertrophy, Left Ventricular/prevention & control , Mitral Valve Insufficiency/drug therapy , Stroke Volume/drug effects , Blood Volume , Heart Failure/etiology , Heart Failure/physiopathology , Heart Ventricles/diagnostic imaging , Heart Ventricles/physiopathology , Humans , Hypertrophy, Left Ventricular/etiology , Hypertrophy, Left Ventricular/physiopathology , Mitral Valve/diagnostic imaging , Mitral Valve/physiopathology , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/physiopathology , Outcome Assessment, Health Care , Treatment Outcome , UltrasonographySubject(s)
American Nurses' Association/organization & administration , Credentialing/organization & administration , Hospitals, Pediatric/standards , Nursing Service, Hospital/standards , Humans , Leadership , Models, Nursing , Nurse Administrators/organization & administration , Ohio , Professional Competence/standards , Quality of Health Care , Total Quality Management/organization & administration , United StatesABSTRACT
What originally started out as mild curiosity quickly became an all-consuming addiction, one that's separated you from family, friends, and a career you feel passionate about. Not only have you lost the trust of your peers during this time, but the entire nursing profession seems suspicious of your intentions. As the cell door shuts, you realize your error. You've subconsciously known it all along, but today it's more obvious than ever. Using recreational drugs, not to mention pilfering prescription drugs, is easily the biggest mistake you've ever made.
