Mazzola, Matteo; Giannini, Cristina; Adamo, Marianna; Stolz, Lukas; Muster, Christian; Butter, Christian; Pfister, Roman; Iliadis, Christos; Melica, Bruno; Sampaio, Francisco; Kalbacher, Daniel; Koell, Benedikt; Spieker, Maximilian; Metra, Marco; Stephan von Bardeleben, Ralph; Karam, Nicole; Kresoja, Karl-Patrik; Lurz, Philipp; Petronio, Anna Sonia; Hausleiter, Jörg; ... (2024). Guideline-Directed Medical Therapy and Survival After TEER for Secondary Mitral Regurgitation With Right Ventricular Impairment. JACC. Cardiovascular Interventions, 17(12), pp. 1455-1466. Elsevier 10.1016/j.jcin.2024.04.025
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BACKGROUND
Right ventricular impairment is common among patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation (SMR). Adherence to guideline-directed medical therapy (GDMT) for heart failure is poor in these patients.
OBJECTIVES
The aim of this study was to evaluate the impact of GDMT on long-term survival in this patient cohort.
METHODS
Within the EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) international registry, we selected patients with SMR and right ventricular impairment (tricuspid annular plane systolic excursion ≤17 mm and/or echocardiographic right ventricular-to-pulmonary artery coupling <0.40 mm/mm Hg). Titrated guideline-directed medical therapy (GDMTtit) was defined as a coprescription of 3 drug classes with at least one-half of the target dose at the latest follow-up. The primary outcome was all-cause mortality at 6 years.
RESULTS
Among 1,213 patients with SMR and right ventricular impairment, 852 had complete data on medical therapy. The 123 patients who were on GDMTtit showed a significantly higher long-term survival vs the 729 patients not on GDMTtit (61.8% vs 36.0%; P < 0.00001). Propensity score-matched analysis confirmed a significant association between GDMTtit and higher survival (61.0% vs 43.1%; P = 0.018). GDMTtit was an independent predictor of all-cause mortality (HR: 0.61; 95% CI: 0.39-0.93; P = 0.02 for patients on GDMTtit vs those not on GDMTtit). Its association with better outcomes was confirmed among all subgroups analyzed.
CONCLUSIONS
In patients with right ventricular impairment undergoing transcatheter edge-to-edge repair for SMR, titration of GDMT to at least one-half of the target dose is associated with a 40% lower risk of all-cause death up to 6 years and should be pursued independent of comorbidities.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology |
UniBE Contributor: |
Muster, Christian |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1876-7605 |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
27 Jun 2024 14:50 |
Last Modified: |
27 Jun 2024 14:59 |
Publisher DOI: |
10.1016/j.jcin.2024.04.025 |
PubMed ID: |
38925749 |
Uncontrolled Keywords: |
guideline-directed medical therapy heart failure right ventricle dysfunction right ventricular–to–pulmonary artery coupling secondary mitral regurgitation transcatheter edge-to-edge repair |
BORIS DOI: |
10.48350/198153 |
URI: |
https://boris.unibe.ch/id/eprint/198153 |
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