Sacubitril/Valsartan may reduce mitral regurgitation in HFrEF, eliminating need for interventions
USA: The severity of mitral regurgitation (MR) in patients with heart failure with reduced ejection fraction (HFrEF) could be reduced by the use of sacubitril/valsartan, says a recent study published in Circulation. The findings were presented at the Heart Failure Society of America (HFSA) 2022 annual scientific meeting by Michael Felker, professor of medicine at Duke University School of Medicine.
The findings from the new analysis of the PROVE-HF study suggest the futility of a mitral-valve intervention in roughly half of the treated patients and stress the importance of guideline-directed medical therapy (GDMT) optimization before treatment of mitral valve disease with either surgery or percutaneous intervention, such as transcatheter edge-to-edge repair (TEER).
The researchers on analyzing 724 people within the trial with interpretable mitral regurgitation data found that sacubitril/valsartan use at 6 months was associated with a 45% relative reduction in the risk of 3-4+ mitral regurgitation and this was sustained out to 12 months with an observed relative reduction of 44.7%.
The researchers conducted an exploratory open-label study with the objective to examine potential cardiac remodeling associated with the use of sacubitril/valsartan among patients with HFrEF. The original findings of the PROVE-HF trial provided evidence indicating the reductions in NT-proBNP observed with the agent; this significantly correlated with improvements in markers of cardiac function and volume at 12 months. The findings from the single-group trial enrolling 794 patients were presented at the ESC Congress 2019 and simultaneously published in JAMA.
The current analysis included 724 individuals after excluding people without interpretable mitral regurgitation data and those with prior mitral valve procedures.
The mean age of the cohort of patients included in the HFSA 2022 data was 65.0±12.4 years, and 1.5% were men. At baseline, 76.4% of patients were using an ACE or ARB and 46.1% had nonischemic heart failure.
As part of the trial's procedure for PROVE-HF echocardiograms were performed at baseline, 6 months, and 12 months. The interpretation of the results was done in a blinded fashion and classified on a scale of 0 (none), 1+ (trace), 2+ mild, 3+ (moderate), and 4+ (severe).
The study led to the following findings:
· Results indicated improvement in mitral regurgitation was observed from baseline through 12 months.
· The prevalence of 3-4+ mitral regurgitation specifically reduced from 14.9% to 8.2% at 6 months, which represents a 45.0% relative reduction in prevalence.
· At 12 months, the prevalence of 3-4+ was 8.4%, which reprints a 44.7% relative reduction.
· Those who experienced a decrease in 3-4+ mitral regurgitations experienced higher reductions in NT-proBNP from baseline to 12 months (912 vs 1512 pg/mL), showed greater improvement in left ventricular remodeling (11.0% vs. 7.6%) and had significantly improved KCCQ-23 scores (82.3 vs. 72.9 compared with non-responders.
Reference:
Januzzi JL, Omar AMS, Liu Y, Murphy S, Butler J, Felker GM, Piña IL, Ward J, Solomon S, Contreras J. Association Between Sacubitril/Valsartan Initiation and Mitral Regurgitation Severity in Heart Failure With Reduced Ejection Fraction: The PROVE-HF Study. Circulation. 2022 Oct 2. doi: 10.1161/CIRCULATIONAHA.122.061693. Epub ahead of print. PMID: 36183276.
