Guideline-directed medical therapy in patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation

Higuchi, Satoshi ; Orban, Mathias; Adamo, Marianna; Giannini, Cristina; Melica, Bruno; Karam, Nicole; Praz, Fabien; Kalbacher, Daniel; Koell, Benedikt; Stolz, Lukas; Braun, Daniel; Näbauer, Michael; Wild, Mirjam; Doldi, Philipp; Neuss, Michael; Butter, Christian; Kassar, Mohammad; Ruf, Tobias; Petrescu, Aniela; Ludwig, Sebastian; Pfister, Roman; Iliadis, Christos; Unterhuber, Matthias; Sampaio, Francisco; Ferreira, Diogo; Thiele, Holger; Baldus, Stephan; Bardeleben, Ralph Stephan von; Massberg, Steffen; Windecker, Stephan; Lurz, Philipp; Petronio, Anna Sonia; Lindenfeld, JoAnn; Abraham, William T.; Metra, Marco und Hausleiter, Jörg (2022): Guideline-directed medical therapy in patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation. In: European Journal of Heart Failure, Bd. 24, Nr. 11: S. 2152-2161

Abstract

Aims Guideline-directed medical therapy (GDMT), based on the combination of beta-blockers (BB), renin-angiotensin system inhibitors (RASI), and mineralocorticoid receptor antagonists (MRA), is known to have a major impact on the outcome of patients with heart failure with reduced ejection fraction (HFrEF). Although GDMT is recommended prior to mitral valve transcatheter edge-to-edge repair (M-TEER), not all patients tolerate it. We studied the association of GDMT prescription with survival in HFrEF patients undergoing M-TEER for secondary mitral regurgitation (SMR). Methods and results EuroSMR, a European multicentre registry, included SMR patients with left ventricular ejection fraction <50%. The outcome was 2-year all-cause mortality. Of 1344 patients, BB, RASI, and MRA were prescribed in 1169 (87%), 1012 (75%), and 765 (57%) patients at the time of M-TEER, respectively. Triple GDMT prescription was associated with a lower 2-year all-cause mortality compared to non-triple GDMT (hazard ratio [HR] 0.74;95% confidence interval [CI] 0.60-0.91). The association persisted in patients with glomerular filtration rate <30 ml/min, ischaemic aetiology, or right ventricular dysfunction. Further, a positive impact of triple GDMT prescription on survival was observed in patients with residual mitral regurgitation of >= 2+ (HR 0.62;95% CI 0.44-0.86), but not in patients with residual mitral regurgitation of <= 1+ (HR 0.83;95% CI 0.64-1.08). Conclusion Triple GDMT prescription is associated with higher 2-year survival after M-TEER in HFrEF patients with SMR. This association was consistent also in patients with major comorbidities or non-optimal results after M-TEER. [GRAPHICS] .

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1388-9842
• Sprache: Englisch
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 491502892