The Results of the Use of Angiotensin Receptor Inhibitors and Neprilisin in Secondary Functional Mitral Regurgitation in Outpatient Practice

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Abstract


Background. Morbidity and mortality in patients with functional mitral regurgitation (FMR) remains high, however, no pharmacological therapy has been proven to be effective. Aims — to study the effect of sacubitrile/valsartan and valsartan on functional mitral regurgitation in chronic heart failure. Methods. This double-blind study randomly assigned sacubitrile/valsartan or valsartan in addition to standard drug therapy for heart failure among 100 patients with heart failure with chronic FMR (secondary to left ventricular (LV) dysfunction). The primary endpoint was a change in the effective area of the regurgitation hole during the 12-month follow-up. Secondary endpoints included changes in the volume of regurgitation, the final systolic volume of the left ventricle, the final diastolic volume of the left ventricle, and the area of incomplete closure of the mitral valves. Results. The decrease in the effective area of the regurgitation hole was significantly more pronounced in the sacubitrile/valsartan group than in the valsartan group (–0.07 ± 0.066 against –0.03 ± 0.058 sm2; p = 0.018) in the treatment efficacy analysis, which included 100 patients (100%). The regurgitation volume also significantly decreased in the sacubitrile/valsartan group compared to the valsartan group (mean difference: –8.4 ml; 95% CI, from –13.2 until –1.9; р = 0.21). There were no significant differences between the groups regarding changes in the area of incomplete closure of the mitral valves and LV volumes, with the exception of the index of the final LV diastolic volume (p = 0.07). Conclusion. Among patients with secondary FMR, sacubitril/valsartan reduced MR more than valsartan. Thus, angiotensin receptor inhibitors and neprilysin can be considered for optimal drug treatment of patients with heart failure and FMR.


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About the authors

Alexey S. Ryazanov

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: alexeydoc72@yandex.ru
ORCID iD: 0000-0003-2823-7774
SPIN-code: 5273-4570

Russian Federation, Moscow

MD, PhD, Professor

Konstantin I. Kapitonov

Clinical and Diagnostic Center No. 4 of the Moscow Department of Health

Email: kapitonov_k.i@rambler.ru
ORCID iD: 0000-0002-2750-0852
SPIN-code: 6331-4986

Russian Federation, Moscow

MD, PhD

Mariya V. Makarovskaya

Clinical and Diagnostic Center No. 4 of the Moscow Department of Health

Author for correspondence.
Email: marja.makarovska@mail.ru
ORCID iD: 0000-0002-2313-2159
SPIN-code: 4937-9454

Russian Federation, Moscow

MD

Alexey A. Kudryavtsev

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: Firstfield@mail.ru
ORCID iD: 0000-0001-8294-5136
SPIN-code: 4403-2229

Russian Federation, Moscow

Аssistant

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