Guideline-directed medical treatment 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; ... (2022). Guideline-directed medical treatment in patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation. European journal of heart failure, 24(11), pp. 2152-2161. Wiley 10.1002/ejhf.2613

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INTRODUCTION

Guideline-directed medical therapy (GDMT), based on the combination of beta blockers (BB), renin-angiotensin system inhibitors (RAS-I), and mineralocorticoid-receptor antagonists (MRA), is known to have a major impact on the outcome of the patients with heart failure with reduced ejection fraction (HFrEF). Although GDMT is recommended prior to M-TEER, not all patients tolerate it. We studied the association of GDMT prescription with survival in HFrEF patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER) for secondary mitral regurgitation (SMR).

METHODS AND RESULTS

EuroSMR, a European multicenter registry, included SMR patients with left ventricular ejection fraction of less than fifty percent. The outcome was 2-year all-cause mortality. Of 1344 patients, BB, RAS-I, 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 of <30ml/min, ischemic etiology, or right ventricular dysfunction. Further, a positive impact of triple GDMT prescription on survival was observed in patients with residual MR of ≥2+ (HR, 0.62; 95% CI, 0.44-0.86), but not in patients with residual MR 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.

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