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

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.