Maximally tolerated dose can reduce mitral regurgitation

Medication was effective in treating nearly 40 percent of heart failure patients experiencing functional mitral regurgitation (FMR) with reduced ejection fraction (HFrEF), according to a new study in JACC: Heart Failure.

A research team from Antwerp University Hospital in Belgium organized a single-center, observational study with 163 patients with a median follow-up time of 56 months. Standard treatment medications in the maximally tolerated dose were given to the patients, who were 76 percent men and had a mean age of 62.

Of the 50 individuals initially diagnosed with severe FMR, 38 percent improved to nonsevere FMR. However, 18 percent of the patients in the nonsevere category evolved to severe FMR despite optimal medical treatment, the authors noted.

They also found the patients who progressed in severity of FMR showed a 13 percent increase in left ventricular end diastolic volume index (LVEDVI), while the patients who improved their MR grade demonstrated a 2 percent decrease in LVEDVI.

“The present study is the first to show that optimal medical heart failure therapy can result in a sustained reduction in severe functional mitral regurgitation in patients with HFrEF, and this reduction in MR was associated with prevention of LV adverse remodeling and with an improved long-term prognosis,” the authors wrote in JACC: Heart Failure.

In all, 56 percent of the patients had a major adverse cardiac event in the follow-up period, and all-cause death occurred in 31 percent of the patients.

Patients with worsening FMR were found to have poor outcomes comparable to patients with sustained severe FMR. On the other hand, patients with improved FMR showed more positive outcomes consistent with sustained nonsevere FMR patients.