Guideline-directed medical therapy assessment in heart failure patients undergoing percutaneous mitral valve repair.

Kresoja, Karl-Patrik; Adamo, Marianna; Rommel, Karl-Phillipp; Stolz, Lukas; Karam, Nicole; Giannini, Cristina; Melica, Bruno; von Bardeleben, Ralph Stephan; Butter, Christian; Horn, Patrick; Praz, Fabien; Kalbacher, Daniel; Iliadis, Christos; Thiele, Holger; Hausleiter, Jörg; Metra, Marco; Lurz, Philipp (2024). Guideline-directed medical therapy assessment in heart failure patients undergoing percutaneous mitral valve repair. ESC Heart Failure, 11(3), pp. 1802-1807. Wiley 10.1002/ehf2.14705

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AIMS

Achieving optimized guideline-directed medical therapy (GDMT) is recommended prior to transcatheter mitral valve edge-to-edge repair (M-TEER) for secondary mitral regurgitation (SMR). We aimed to propose and validate an easy-to-use score for assessing the quality of GDMT in patients with heart failure with reduced ejection fraction (HFrEF) undergoing M-TEER.

METHODS AND RESULTS

Among the 1641 EuroSMR patients enrolled in the EuroSMR Registry who underwent M-TEER, a total of 1072 patients [median age 74, interquartile range (IQR) 67-79 years, 29% female] had complete data on GDMT and a left ventricular ejection fraction ≤ 40% and were included in the current study. We proposed a GDMT score that considers the dosage levels of three medication classes (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors, beta-blockers, and mineralocorticoid receptor antagonists), with a maximum score of 12 points indicating optimal GDMT. The primary outcome was all-cause mortality. The median GDMT score was 4 points (IQR 3-6). All three domains of the scoring system were associated with all-cause mortality (P < 0.05 for all). The overall GDMT score was associated with all-cause mortality (hazard ratio 0.90, 95% confidence interval 0.86-0.95 for each 1-point increase in the GDMT score). This association remained significant after adjusting for renal function and co-morbidities.

CONCLUSIONS

This study demonstrates the utility of a simple GDMT scoring system for assessing the adequacy of GDMT in HFrEF patients with relevant SMR undergoing M-TEER. The GDMT score has potential applications in guiding the design of future clinical trials and aiding clinical decision-making processes.

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