Introduction
Sacubitril/Valsartan is a first-in-class combination of angiotensin receptor blocker (ARB) and neprilysin inhibitor. It is now recommended for the treatment of chronic heart failure with reduced ejection fraction (HFrEF) that remains symptomatic despite optimal treatment as per international guidelines. (1)
Compared with enalapril, sacubitril/valsartan reduced the composite endpoint of cardiovascular death or HF hospitalization and is recommended as an alternative for angiotensin‐converting enzyme inhibitors (ACEI) and (ARB) in patients with HFrEF and New York Heart Association (NYHA) class II–III symptoms. (2, 3)
In the randomized controlled trial PRIME (Pharmacological Reduction of Functional, Ischemic Mitral Regurgitation) sacubitril/valsartan treatment resulted in a greater reduction of Mitral Regurgitation (MR) associated with HF compared to valsartan alone. (4)
In our patient, who presented with acute decompensated HF, dramatic reduction in secondary MR severity as well as significant left ventricular (LV) function improvement were achieved after using Angiotensin Receptor-Neprilysin inhibitor (ARNI)