Guideline-directed medical therapy in patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation
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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; von Bardeleben, Ralph Stephan; Massberg, Steffen; Windecker, Stephan; Lurz, Philipp; Petronio, Anna Sonia; Lindenfeld, JoAnn; Abraham, William T; Metra, Marco; Hausleiter, Jörg; EuroSMR Investigators.
In: EUR J HEART FAIL, Vol. 24, No. 11, 11.2022, p. 2152-2161.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Guideline-directed medical therapy in patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation
AU - Higuchi, Satoshi
AU - Orban, Mathias
AU - Adamo, Marianna
AU - Giannini, Cristina
AU - Melica, Bruno
AU - Karam, Nicole
AU - Praz, Fabien
AU - Kalbacher, Daniel
AU - Koell, Benedikt
AU - Stolz, Lukas
AU - Braun, Daniel
AU - Näbauer, Michael
AU - Wild, Mirjam
AU - Doldi, Philipp
AU - Neuss, Michael
AU - Butter, Christian
AU - Kassar, Mohammad
AU - Ruf, Tobias
AU - Petrescu, Aniela
AU - Ludwig, Sebastian
AU - Pfister, Roman
AU - Iliadis, Christos
AU - Unterhuber, Matthias
AU - Sampaio, Francisco
AU - Ferreira, Diogo
AU - Thiele, Holger
AU - Baldus, Stephan
AU - von Bardeleben, Ralph Stephan
AU - Massberg, Steffen
AU - Windecker, Stephan
AU - Lurz, Philipp
AU - Petronio, Anna Sonia
AU - Lindenfeld, JoAnn
AU - Abraham, William T
AU - Metra, Marco
AU - Hausleiter, Jörg
AU - EuroSMR Investigators
N1 - © 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2022/11
Y1 - 2022/11
N2 - 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.
AB - 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.
KW - Humans
KW - Heart Failure/drug therapy
KW - Stroke Volume
KW - Ventricular Function, Left
U2 - 10.1002/ejhf.2613
DO - 10.1002/ejhf.2613
M3 - SCORING: Journal article
C2 - 35791663
VL - 24
SP - 2152
EP - 2161
JO - EUR J HEART FAIL
JF - EUR J HEART FAIL
SN - 1388-9842
IS - 11
ER -
