Hydralazine combined with conventional therapy improved outcomes in severe systolic dysfunction and mitral regurgitation

Abstract

Abstract Aims Patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF) accompanied by significant mitral regurgitation (MR) had poor outcome. Several vasodilator trials showed neutral results. We aimed to investigate the effect of early up‐titration of hydralazine combined with conventional treatment in acute HF with severe systolic dysfunction and significant MR. Methods and results The study was open‐labelled, one‐to‐one ratio randomized designed. Consecutively hospitalized patients with decompensated HF symptoms, LVEF 0.05) at study end. Side effects did not differ between the two groups. Finally, 51% (104 out of 203 cases) reached endpoints in conventional group and 34.6% (71 out of 205 cases) in hydralazine + conventional treatment group, which had a significant reduction in CV events (hazard ratio 0.613, 95% confidence interval 0.427–0.877, P < 0.001). In‐hospital death during the index admission was significantly higher in conventional group (5.4% vs. 0.5%, respectively; P = 0.001). Conclusions When administered without inadequate preload, combining early up‐titration of hydralazine with EBMs improves outcome in patients with severe systolic dysfunction and significant MR, and it is safe and well tolerated.

Keywords

• Hydralazine
• Loop diuretic
• Evidence‐based medications
• Mitral regurgitation
• Systolic heart failure
• Outcome