Impact of Transcatheter Edge-to-Edge Mitral Valve Repair on Guideline-Directed Medical Therapy Uptitration
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Impact of Transcatheter Edge-to-Edge Mitral Valve Repair on Guideline-Directed Medical Therapy Uptitration. / Adamo, Marianna; Tomasoni, Daniela; Stolz, Lukas; Stocker, Thomas J; Pancaldi, Edoardo; Koell, Benedikt; Karam, Nicole; Besler, Christian; Giannini, Cristina; Sampaio, Francisco; Praz, Fabien; Ruf, Tobias; Pechmajou, Louis; Neuss, Michael; Iliadis, Christos; Baldus, Stephan; Butter, Christian; Kalbacher, Daniel; Lurz, Philipp; Melica, Bruno; Petronio, Anna S; Stephan von Bardeleben, Ralph; Windecker, Stephan; Butler, Javed; Fonarow, Gregg C; Hausleiter, Jörg; Metra, Marco.
in: JACC-CARDIOVASC INTE, Jahrgang 16, Nr. 8, 24.04.2023, S. 896-905.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Impact of Transcatheter Edge-to-Edge Mitral Valve Repair on Guideline-Directed Medical Therapy Uptitration
AU - Adamo, Marianna
AU - Tomasoni, Daniela
AU - Stolz, Lukas
AU - Stocker, Thomas J
AU - Pancaldi, Edoardo
AU - Koell, Benedikt
AU - Karam, Nicole
AU - Besler, Christian
AU - Giannini, Cristina
AU - Sampaio, Francisco
AU - Praz, Fabien
AU - Ruf, Tobias
AU - Pechmajou, Louis
AU - Neuss, Michael
AU - Iliadis, Christos
AU - Baldus, Stephan
AU - Butter, Christian
AU - Kalbacher, Daniel
AU - Lurz, Philipp
AU - Melica, Bruno
AU - Petronio, Anna S
AU - Stephan von Bardeleben, Ralph
AU - Windecker, Stephan
AU - Butler, Javed
AU - Fonarow, Gregg C
AU - Hausleiter, Jörg
AU - Metra, Marco
N1 - Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2023/4/24
Y1 - 2023/4/24
N2 - BACKGROUND: Guideline-directed medical therapy (GDMT) optimization is mandatory before transcatheter edge-to-edge mitral valve repair (M-TEER) in patients with secondary mitral regurgitation (SMR) and heart failure (HF) with reduced ejection fraction (HFrEF). However, the effect of M-TEER on GDMT is unknown.OBJECTIVES: The authors sought to evaluate frequency, prognostic implications and predictors of GDMT uptitration after M-TEER in patients with SMR and HFrEF.METHODS: This is a retrospective analysis of prospectively collected data from the EuroSMR Registry. The primary events were all-cause death and the composite of all-cause death or HF hospitalization.RESULTS: Among the 1,641 EuroSMR patients, 810 had full datasets regarding GDMT and were included in this study. GDMT uptitration occurred in 307 patients (38%) after M-TEER. Proportion of patients receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors, beta-blockers, and mineralocorticoid receptor antagonists was 78%, 89%, and 62% before M-TEER and 84%, 91%, and 66% 6 months after M-TEER (all P < 0.001). Patients with GDMT uptitration had a lower risk of all-cause death (adjusted HR: 0.62; 95% CI: 0.41-0.93; P = 0.020) and of all-cause death or HF hospitalization (adjusted HR: 0.54; 95% CI: 0.38-0.76; P < 0.001) compared with those without. Degree of MR reduction between baseline and 6-month follow-up was an independent predictor of GDMT uptitration after M-TEER (adjusted OR: 1.71; 95% CI: 1.08-2.71; P = 0.022).CONCLUSIONS: GDMT uptitration after M-TEER occurred in a considerable proportion of patients with SMR and HFrEF and is independently associated with lower rates for mortality and HF hospitalizations. A greater decrease in MR was associated with increased likelihood for GDMT uptitration.
AB - BACKGROUND: Guideline-directed medical therapy (GDMT) optimization is mandatory before transcatheter edge-to-edge mitral valve repair (M-TEER) in patients with secondary mitral regurgitation (SMR) and heart failure (HF) with reduced ejection fraction (HFrEF). However, the effect of M-TEER on GDMT is unknown.OBJECTIVES: The authors sought to evaluate frequency, prognostic implications and predictors of GDMT uptitration after M-TEER in patients with SMR and HFrEF.METHODS: This is a retrospective analysis of prospectively collected data from the EuroSMR Registry. The primary events were all-cause death and the composite of all-cause death or HF hospitalization.RESULTS: Among the 1,641 EuroSMR patients, 810 had full datasets regarding GDMT and were included in this study. GDMT uptitration occurred in 307 patients (38%) after M-TEER. Proportion of patients receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors, beta-blockers, and mineralocorticoid receptor antagonists was 78%, 89%, and 62% before M-TEER and 84%, 91%, and 66% 6 months after M-TEER (all P < 0.001). Patients with GDMT uptitration had a lower risk of all-cause death (adjusted HR: 0.62; 95% CI: 0.41-0.93; P = 0.020) and of all-cause death or HF hospitalization (adjusted HR: 0.54; 95% CI: 0.38-0.76; P < 0.001) compared with those without. Degree of MR reduction between baseline and 6-month follow-up was an independent predictor of GDMT uptitration after M-TEER (adjusted OR: 1.71; 95% CI: 1.08-2.71; P = 0.022).CONCLUSIONS: GDMT uptitration after M-TEER occurred in a considerable proportion of patients with SMR and HFrEF and is independently associated with lower rates for mortality and HF hospitalizations. A greater decrease in MR was associated with increased likelihood for GDMT uptitration.
KW - Humans
KW - Heart Failure
KW - Mitral Valve/diagnostic imaging
KW - Retrospective Studies
KW - Treatment Outcome
KW - Stroke Volume
KW - Mitral Valve Insufficiency/diagnostic imaging
U2 - 10.1016/j.jcin.2023.01.362
DO - 10.1016/j.jcin.2023.01.362
M3 - SCORING: Journal article
C2 - 37100553
VL - 16
SP - 896
EP - 905
JO - JACC-CARDIOVASC INTE
JF - JACC-CARDIOVASC INTE
SN - 1936-8798
IS - 8
ER -
