Background. Morbidity and mortality in patients with functional mitral regurgitation (FMR) remains high, however, no pharmacological therapy has been proven to be effective.Aimsto 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 (0.070.066against0.030.058sm2; p=0.018)in the treatment efficacy analysis, which included 100patients (100%). The regurgitation volume also significantly decreased in the sacubitrile/valsartan group compared to the valsartan group (mean difference:8.4ml; 95%CI, from 13.2 until 1.9;р=0.21). There were no significant differences between the groups regarding changes in the area ofincomplete 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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Objective: sacubitrile/valsartan is superior to valsartan in modifying functional mitral regurgitation (MR) for the better thanks to the double inhibition of the renin-angiotensin and neprilysin system. Material and methods. This double-blind study randomly assigned sacubitrile/valsartan or valsartan in addition to standard drug therapy for heart failure among 90 patients with heart failure with chronic functional MR (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 (–0.048 ± 0.095 vs –0.012 ± 0.105 cm2; p = 0.032) in the treatment efficacy analysis, which included 90 patients (100%). The regurgitation volume also significantly decreased in the sacubitrile/valsartan group compared to the valsartan group (mean difference –7.3 ml; 95% CI 12.6–1.9; p = 0.009). 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 (р = 0.044). There were no significant differences in the change in blood pressure between the two treatment groups. Conclusion. Among patients with secondary functional MR, sakubitril/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 functional MR.

им. И. М. Сеченова Минздрава России (Сеченовский Университет). Москва; 2 ГБУЗ Клинико-диагностический центр № 4 Департамента здравоохранения Москвы. Москва, Россия АГ-артериальная гипертония, АД-артериальное давление, АК-аортальный клапан, АС-аортальный стеноз, ГЛЖ-гипертрофия левого желудочка, ДАД-диастолическое АД, ДП-двойное произве дение, ИММ-индекс массы миокарда, ИМТ-индекс массы тела, КДР-конечный диастолический размер, ЛЖ-левый желудочек, ОТСд-относительная толщина стенки ЛЖ в диастолу, ОТСс-относи тельная толщина стенки ЛЖ в систолу, САД-систолическое АД, ССС-сердечнососудистое(ые) событие(ия), ТЗС-толщина задней стенки, ТЗСд-ТЗС в диастолу, ТЗСс-ТЗС в систолу, ТМЖП-тол щина межжелудочковой перегородки, ТМЖПд-ТМЖП в диастолу, ТМЖПс-ТМЖП в систолу, ФВ-фракция выброса, ЧСС-частота сердечных сокращений, ЭхоКГ-эхокардиография.