From the Guidelines
Yes, progression of valvular insufficiency can be slowed down through effective medical therapy and interventions. The most recent and highest quality study, 1, suggests that indications for intervention for valvular regurgitation are relief of symptoms and prevention of the irreversible long-term consequences of left ventricular volume overload. Key approaches to slowing down the progression of valvular regurgitation include:
- Medical management focusing on controlling blood pressure, reducing cardiac workload, and managing symptoms
- Use of ACE inhibitors, ARBs, beta-blockers, and diuretics to reduce afterload, decrease regurgitant volume, control heart rate, and relieve fluid overload symptoms
- Lifestyle modifications such as maintaining optimal blood pressure, following a low-sodium diet, engaging in appropriate physical activity, achieving optimal weight, and avoiding tobacco
- Regular echocardiographic monitoring to track disease progression These interventions work by reducing the pressure gradient across the affected valve, decreasing ventricular wall stress, preventing ventricular remodeling, and minimizing the hemodynamic burden on the heart, potentially slowing the progression of valvular regurgitation and delaying the need for surgical intervention, as supported by 1 and 1. In specific cases, such as severely symptomatic primary or secondary mitral regurgitation, mitral transcatheter edge-to-edge repair may be beneficial, as noted in 1. Additionally, surgical intervention may be considered for patients with severe symptomatic isolated tricuspid regurgitation or bioprosthetic valve dysfunction, as outlined in 1. Overall, a comprehensive approach combining medical management, lifestyle modifications, and timely interventions can help slow down the progression of valvular insufficiency and improve patient outcomes.
From the Research
Valvular Insufficiency Progression
The progression of valvular insufficiency, also known as regurgitation, can potentially be slowed down through various treatments.
- Beta-blockers have been found to have a role in the management of valvular disorders, including the reduction of valve-related hemolysis and the prevention of atrial fibrillation 2.
- Angiotensin converting enzyme (ACE) inhibitors have been shown to decrease preload and afterload, and may be of potential value in valvular regurgitation 3.
- A study found that long-term ACE inhibition in patients with valvular regurgitation reverses left ventricular dilation and reduces left ventricular mass and hypertrophy, thereby improving left ventricular function 3.
- Vasodilator drug therapy may also be beneficial for asymptomatic patients with severe aortic regurgitation and preserved left ventricular function 4.
Treatment Options
Different treatment options are available for valvular insufficiency, including:
- Surgery, which is recommended for severe primary mitral regurgitation if persistent symptoms are present or if left ventricle dysfunction is present 5.
- Coronary artery bypass grafts (CABG) or percutaneous coronary intervention (PCI) for severe mitral regurgitation due to ischemia 5.
- Therapy of heart failure with vasodilators and diuretics to improve forward cardiac output in patients with secondary mitral regurgitation 5.