# PRAISE-MR: sacubitril-valsartan verbetert inspanningshemodynamiek bij HFpEF met atriale mitralisinsufficiëntie

*geplaatst 2026-05-10 · Hartfalen · Circulation · doi 10.1161/CIRCULATIONAHA.126.080833 · https://hartvaat.nl/2026/05/09/praise-mr-sacubitril-valsartan-verbetert-inspanningshemodynamiek-bij-hfpef-met-a/*

PRAISE-MR — een Belgische multicentrische, gerandomiseerde open-label trial — wijst sacubitril-valsartan voor het eerst aan als medicamenteuze optie bij HFpEF met atriale functionele mitralisinsufficiëntie (AFMR). 84 patiënten met symptomatische HFpEF en ten minste matige AFMR werden gerandomiseerd naar sacubitril-valsartan (n=41) of standaardzorg (n=43). Na 6 maanden was de toename van de inspannings-mPAP/CO-helling — gemeten via cardiopulmonaal inspanningsonderzoek met simultane echocardiografie — significant gunstiger met sacubitril-valsartan (verschil −0,93 mmHg/L/min; 95% BI −1,80 tot −0,07; p=0,035). De winst vertaalde zich in betere piek-VO2 (+0,9 vs −0,6 mL/kg/min; p=0,002), KCCQ-score (mediane stijging 10 vs 2 punten; p=0,002), lagere NT-proBNP en LA-volume, en attenuatie van AFMR in rust en tijdens inspanning. Conclusie: in symptomatische HFpEF met AFMR levert sacubitril-valsartan over zes maanden hemodynamische, functionele én structurele winst — de eerste medicamenteuze interventie met klinisch betekenisvolle effecten in dit hoog-risico fenotype.

## English: 

PRAISE-MR is the first medical-therapy trial demonstrating exercise-hemodynamic benefit in HFpEF with atrial functional mitral regurgitation (AFMR). In 84 patients randomized to sacubitril-valsartan or standard of care, the 6-month change in exercise mPAP/CO slope improved by 0.93 mmHg/L/min with sacubitril-valsartan (95% CI 0.07–1.80; p=0.035). Peak VO2, KCCQ score, NT-proBNP, LA volume and AFMR severity all improved. The findings position ARNI as a credible disease-modifying option for HFpEF + AFMR, alongside transcatheter mitral repair as evidence emerges.

## Abstract (original, from the publication)

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: -0.93 mmHg/L/min; 95%CI: -1.80 to -0.07; p=0.035). This hemodynamic benefit was accompanied by improvements in peak VO2 (+0.9 vs. -0.6 mL/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, alongside attenuation of AFMR severity at rest and during exercise. Conclusions: In symptomatic HFpEF with secondary AFMR, sacubitril/valsartan improved exercise hemodynamics, exercise capacity, quality of life, and biomarker and structural endpoints over six months.

Auteurs: Sebastiaan Dhont, Sara Moura Ferreira, Xavier Galloo, Pieter Martens, Evelyne Meekers, Wilfried Mullens, Frederik H Verbrugge

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Bron: Circulation, https://doi.org/10.1161/CIRCULATIONAHA.126.080833. Bijgewerkt 2026-07-03T13:31:48Z. 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.