Angiotensin-II Blockade in Mitral Regurgitation

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00587470
Recruitment Status : Completed
First Posted : January 7, 2008
Last Update Posted : October 15, 2010
Information provided by:
Mayo Clinic

Brief Summary:
Mitral regurgitation (MR) is common in the elderly and its prevalence is increasing with the aging of the population. Organic MR, due to primary valvular lesions, initiates a cascade of complications determined by its degree. MR of severe degree is associated with excess mortality and high cardiac morbidity (heart failure, atrial fibrillation). It also causes left ventricular remodeling which induces left ventricular dysfunction, which in turn leads to poor clinical outcome. Surgery can eliminate MR, but carries immediate and long-term risks, especially in the elderly. Therefore, chronically decreasing the degree of MR is a major goal of medical therapy but such an effect is yet unproved because of conflicting results of small and mostly non-randomized series. Our recent preliminary studies suggest that a sustained decrease of degree of MR and improvement of left ventricular remodeling can be achieved with powerful reduction of afterload, obtained in particular with angiotensin-II receptor blockade. Therefore, the present proposal seeks to address gaps of knowledge regarding vasoactive treatment of MR through the verification of the following hypothesis: Hypothesis: Vasoactive therapy using angiotensin-II receptor blocker (Candesartan Cilexetil) weighed against placebo produces a sustained reduction of the consequences of organic MR. The specific aims are that the treatment a) decreases the degree of MR (decreases the regurgitant volume, primary end-point) and b) improves left ventricular remodeling (decreases the end-diastolic volume index, secondary end-point), as compared to placebo.

Condition or disease Intervention/treatment Phase
Mitral Regurgitation Drug: Candesartan Drug: atacand Drug: Placebo Phase 4

Detailed Description:
Patients with MR organic (intrinsic valve disease), isolated (no other valve disease), moderate or more severe (regurgitant volume *30 mL/beat). A Clinical trial, randomized, placebo controlled, double-blind, without cross-over, of 1 year oral treatment with potent angiotensin-II receptor blockade using 32 mg Candesartan daily. The trial is preceded in all patients by an acute open-label study to determine tolerance and immediate response. The methods used to measure the end-points will be: a) Doppler-Echocardiography for quantitation of the degree of MR (measurement of regurgitant volume) using a combination of three simultaneous methods (quantitative Doppler, quantitative two-dimensional echocardiography, proximal flow convergence) and b) of left ventricular remodeling (end-diastolic volume index measured by echocardiography and by electron beam computed tomography). This single center study seeks to enroll a total of 90 patients. The analysis will be based on intention to treat and compare the regurgitant volume and left ventricular end-diastolic volume index measured after one year of treatment with the active drug or placebo. The results of the trial should provide strong evidence regarding medical treatment of patients with organic MR.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 60 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Angiotensin-II Blockade in Mitral Regurgitation
Study Start Date : August 1998
Actual Primary Completion Date : August 2001
Actual Study Completion Date : August 2001

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: 1
Atacand treatment.
Drug: Candesartan
Maximum vasodilation.
Other Name: atacand

Drug: atacand
maximum vasodilation
Other Name: candesartan

Placebo Comparator: 2
Drug: Placebo

Primary Outcome Measures :
  1. Tolerance of the medication. [ Time Frame: one year ]

Secondary Outcome Measures :
  1. Decrease of severity of mitral regurgitation. [ Time Frame: 1 year ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:


  • 18 years old or older, with
  • Mitral regurgitation on the basis of Color flow imaging
  • Due to organic disease of the mitral valve on the basis of two-dimensional echocardiography
  • Isolated (no valve disease other than functional tricuspid regurgitation on the basis of Doppler-Echocardiography)
  • Pure (no mitral stenosis by Doppler echocardiography)
  • Quantifiable by Doppler-Echocardiographic methods
  • Of more than mild degree, defined as regurgitant volume * 30 mL/beat
  • Occurring on native valves
  • With Two-dimensional echocardiographic imaging allowing assessment of LV remodeling, and
  • Asymptomatic (or mildly symptomatic but not considered as candidates for immediate surgery by their attending physician).

Exclusion Criteria:

  • Associated aortic valve disease (more than trace aortic regurgitation by color flow imaging or mean gradient *25 mmHg)
  • Associated mitral stenosis (mean gradient* 5 mmHg, valve area < 1.5 cm2)
  • Associated congenital or pericardial diseases on the basis of Doppler echocardiography
  • Intolerance to either AII blockers or Angiotensin converting enzyme inhibitors
  • Intolerance to iodine contrast material
  • Intolerance to intravenous echographic contrast agents
  • Renal failure with creatinine * 2 mg/dl
  • Blood pressure below 100 mmHg
  • Known renal artery stenosis
  • Ongoing therapy with hydralazine, calcium-entry blocking drugs or angiotensin converting enzyme inhibitors
  • Known severe comorbidity such as liver disease, malignancy
  • Pregnancy (A negative pregnancy test and effective contraceptive methods are required prior to enrollment of females of childbearing potential (not post-menopausal or surgically sterilized)), and
  • Patients considered as requiring mitral valve surgery by their attending physician or with previous valve repair or replacement.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00587470

United States, Minnesota
Mayo Clinic
Rochester, Minnesota, United States, 55905`
Sponsors and Collaborators
Mayo Clinic
Principal Investigator: Maurice E. Sarano, M.D. Mayo Clinic Foundation

Responsible Party: Maurice Enriquez-Sarano M.D., Mayo Clinic Foundation Identifier: NCT00587470     History of Changes
Obsolete Identifiers: NCT00014846
Other Study ID Numbers: 1129-98
First Posted: January 7, 2008    Key Record Dates
Last Update Posted: October 15, 2010
Last Verified: October 2010

Keywords provided by Mayo Clinic:
valve, mitral, regurgitation

Additional relevant MeSH terms:
Mitral Valve Insufficiency
Heart Valve Diseases
Heart Diseases
Cardiovascular Diseases
Candesartan cilexetil
Angiotensin II
Antihypertensive Agents
Angiotensin II Type 1 Receptor Blockers
Angiotensin Receptor Antagonists
Molecular Mechanisms of Pharmacological Action
Vasoconstrictor Agents
Serine Proteinase Inhibitors
Protease Inhibitors
Enzyme Inhibitors