Effect of Sacubitril-Valsartan on Secondary Mitral Regurgitation and Left Ventricular Reverse Remodeling in Patients With Heart Failure With Reduced Ejection Fraction: A 2D and 3D Echocardiographic Study.

After 1 year of S/V therapy, patients with HFrEF demonstrated marked and consistent improvements in both MR and (LV) structure and function. EROA decreased from 0.36 ± 0.08 cm2 to 0.24 ± 0.09 cm2 (-34.6%, p < 0.001), accompanied by reductions in regurgitant volume (RV) (-32.6%, p < 0.001) and regurgitant fraction (-30.8%, p < 0.001). LVRR was evidenced by significant increases in LVEF (3D: +42.1%, p < 0.001, Cohen's d = 2.63) and reductions in LVEDV (-18.0%, p < 0.001) and LVESV (-31.8%, p < 0.001), as well as a 14.7% decrease in LVMI (p < 0.001). Correlation analysis revealed that MR improvement closely paralleled LV remodeling, with ΔEROA strongly associated with reductions in LVESVI (r = 0.774, p < 0.001), LVEDVI (r = 0.558, p < 0.001), and LVEF improvement (r = -0.781, p < 0.001). Multivariable regression identified lower baseline LVEF (3D) as the strongest independent predictor of LVRR (β = -2.304, p < 0.001) CONCLUSIONS: S/V therapy induces significant and comprehensive LVRR and a marked reduction in secondary MR severity in HFrEF patients. The strong correlation between these two effects suggests that MR improvement is primarily driven by LVRR. Lower baseline LVEF is a powerful predictor of the magnitude of LVRR.