March 30, 2016Open Access
The Role of Medical Therapy in Moderate to Severe Degenerative Mitral Regurgitation
Key Result
Medical therapy with beta-blockers and ACE inhibitors reduces afterload, lessens mitral regurgitation, and prevents left ventricular remodeling in patients with primary mitral regurgitation.
Study Design
Type
Systematic Review
Structured PICO
Does medical therapy (beta-blockers and RAAS inhibitors) improve outcomes in patients with moderate to severe primary mitral regurgitation?
P
Population
Patients with moderate to severe primary (degenerative) mitral regurgitation
I
Intervention
Medical therapy (specifically beta-blockers and renin-angiotensin-aldosterone system inhibitors)
O
Outcome
Mitral regurgitation severity, left ventricular function, and survival
Medical therapy with beta-blockers and RAAS inhibitors may offer symptomatic and prognostic benefits in moderate to severe primary mitral regurgitation, potentially delaying the need for surgery.
Limitations
- Mostly small studies with different MR etiologies, patient populations, and durations of therapy
- Lack of large, randomized prospective trial data
- Some studies lacked control groups
- Confounding from patients taking other cardioactive medications
- Lack of quantitative analysis of the MR in some studies
- Difficult to differentiate whether beneficial effects are due to improvement in LV function or reduction in MR severity
Abstract
Mitral regurgitation (MR) is a common valvular disorder that has important health and economic consequences. Standardized guidelines exist regarding when and in whom to perform mitral valve surgery, but little information is available regarding medical treatment of MR. Many patients with moderate or severe MR do not meet criteria for surgery or are deemed to be at high risk for surgical therapy. We reviewed the available published data on medical therapy in the treatment of patients with primary MR. b-blockers and renin-angiotensin-aldosterone system inhibitors had the strongest supporting evidence for providing beneficial effects. b-blockers appear to lessen MR, prevent deterioration of left ventricular function, and improve survival in asymptomatic patients with moderate to severe primary MR. Angiotensin-converting enzyme inhibitor and angiotensin receptor blocker therapy reduces MR, especially in asymptomatic patients. However, in the setting of hypertrophic cardiomyopathy or mitral valve prolapse, vasodilators can increase the severity of MR. To define the precise role of medical therapy, a larger randomized controlled trial is needed to confirm benefit and assess in which subsets of patients medical therapy is most useful. Medical therapy in some patients improves symptoms, lessens MR, and may delay the need for surgical intervention.
Cite This Study
Slipczuk et al. (Wed,) conducted a systematic review in Moderate to severe primary (degenerative) mitral regurgitation. Medical therapy (beta-blockers, ACE inhibitors, ARBs, vasodilators) vs. Placebo or no medical therapy was evaluated on Hemodynamic parameters, left ventricular function, and clinical outcomes (qualitative synthesis). Medical therapy with beta-blockers and ACE inhibitors reduces afterload, lessens mitral regurgitation, and prevents left ventricular remodeling in patients with primary mitral regurgitation.