{"id":"45992","type":"article","url":"https://hartvaat.nl/2026/05/09/praise-mr-sacubitril-valsartan-verbetert-inspanningshemodynamica-bij-hfpef-met-a/","title":"PRAISE-MR: sacubitril/valsartan verbetert inspanningshemodynamica bij HFpEF met atriale functionele mitralis-insufficiëntie","title_en":"Angiotensin Receptor Neprilysin Inhibitor in Heart Failure With Preserved Ejection Fraction and Secondary Mitral Regurgitation: The PRAISE-MR Randomized Trial","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.126.080833","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.126.080833","authors":["Sebastiaan Dhont"],"significance":8,"published":"2026-07-09","source_date":"2026-05-09","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/tricuspidalisregurgitatie/","https://hartvaat.nl/kennis/diagnostiek/inspanningstest-loopband-fiets/"],"congress":"","summary_en":"Multicenter open-label randomised trial with blinded primary endpoint in 84 patients with symptomatic HFpEF and ≥moderate atrial functional mitral regurgitation (AFMR), randomised to sacubitril/valsartan (n=41) or standard of care (n=43). The primary endpoint was change in exercise mPAP/CO slope (mean pulmonary arterial pressure to cardiac output) measured via cardiopulmonary exercise testing with simultaneous echocardiography. At 6 months, mPAP/CO slope significantly improved with sacubitril/valsartan (adjusted between-group difference -0.93 mm Hg/L/min; 95% CI -1.80 to -0.07; p=0.035). Accompanying benefits: higher peak VO2 (+0.9 vs -0.6 mL/kg/min; p=0.002), higher KCCQ score (+10 vs +2 points; p=0.002), significantly lower NT-proBNP and LA volume (both p<0.001), and attenuation of the dynamic MR increase during exercise (p=0.020). Target dose was achieved in 60%; symptomatic hypotension was the main titration-limiting factor. A phenotype-specific benefit warranting confirmation in larger outcome trials.","created":"2026-07-03T20:27:03Z","updated":"2026-07-04T19:27:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Multicenter gerandomiseerde open-label trial met geblindeerd primair eindpunt bij 84 patiënten met symptomatisch HFpEF en ≥matige atriale functionele mitralis-insufficiëntie (AFMR), gerandomiseerd tussen sacubitril/valsartan (n=41) en standaardzorg (n=43). Het primaire eindpunt was de verandering van de mPAP/CO-slope (gemiddelde pulmonale arteriële druk per cardiac output) tijdens inspanning, gemeten via cardiopulmonale inspanningstest met simultane echocardiografie. Na 6 maanden verbeterde de mPAP/CO-slope significant in de sacubitril/valsartan-arm (gecorrigeerd verschil -0,93 mmHg/L/min; 95%-BI -1,80 tot -0,07; p=0,035). Begeleidende voordelen: hogere piek-VO2 (+0,9 vs -0,6 mL/kg/min; p=0,002), hogere KCCQ-score (+10 vs +2 punten; p=0,002), significant lagere NT-proBNP en LA-volume (beide p<0,001), én vermindering van dynamische MR-toename tijdens inspanning (p=0,020). Doeldosis werd bereikt bij 60%; symptomatische hypotensie was de voornaamste titratie-belemmering. Fenotype-specifiek voordeel dat bevestiging in grotere outcomes-trials verdient.","abstract_original":"Background: Atrial functional mitral regurgitation (AFMR) characterizes a high-risk phenotype in heart failure with preserved ejection fraction (HFpEF). Although sacubitril/valsartan reduces functional MR in HF with reduced EF (HFrEF), its impact on exercise hemodynamics and the dynamic burden of AFMR in HFpEF remains to be elucidated.Methods: This multicenter, randomized, open-label trial with blinded primary endpoint assessment assigned 84 patients with symptomatic HFpEF and ≥moderate AFMR within the previous year to sacubitril/valsartan (n=41) or standard-of-care (SOC; n=43). The primary outcome was the 6-month change in the exercise mean pulmonary arterial pressure to cardiac output (mPAP/CO) slope, assessed using cardiopulmonary exercise testing with simultaneous echocardiography (CPETecho). Secondary outcomes included changes in peak oxygen consumption (peak VO2), Kansas City Cardiomyopathy Questionnaire (KCCQ), NT-proBNP levels, LA volume and function, and AFMR severity in rest and during stress.Results: At 6 months, sacubitril/valsartan significantly improved the mPAP/CO slope compared to SOC (adjusted between-group difference in change: -0.93mmHg/L/min; 95%CI: -1.80 to -0.07; p=0.035). This hemodynamic benefit was accompanied by improvements in peak VO2 (mean change: +0.9 vs. -0.6mL/kg/min; p=0.002) and KCCQ (median increase: 10 vs. 2 points; p=0.002). Significant reductions in NT-proBNP and LA volume were observed (p&amp;lt;0.001 for both), alongside a significant blunting of the dynamic MR increase during exercise (p=0.020). Target dose was achieved in 60% of patients, with symptomatic hypotension as the primary titration-limiting factor.Conclusions: In HFpEF and AFMR, sacubitril/valsartan was associated with improvements in exercise hemodynamics and peak VO2, along with attenuation of the exercise-induced increase in AFMR. These findings suggest a phenotype-specific benefit, warranting confirmation in larger, placebo-controlled, clinical outcome trials."}