Article Text

Download PDFPDF
Original research
Guideline-directed medical therapy after transcatheter edge-to-edge mitral valve repair
  1. Tetsu Tanaka1,
  2. Refik Kavsur1,
  3. Maximilian Spieker2,
  4. Christos Iliadis3,
  5. Clemens Metze3,
  6. Birthe M Brachtendorf1,
  7. Patrick Horn2,
  8. Christian Zachoval1,
  9. Atsushi Sugiura1,
  10. Malte Kelm2,
  11. Stephan Baldus3,
  12. Georg Nickenig1,
  13. Ralf Westenfeld2,
  14. Roman Pfister3,
  15. Marc Ulrich Becher1
  1. 1Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
  2. 2Heart Center, Department of Cardiology, University Hospital of Düsseldorf, Düsseldorf, Germany
  3. 3Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
  1. Correspondence to Dr. Marc Ulrich Becher, Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; ubecher{at}uni-bonn.de

Abstract

Objective A sizeable proportion of patients with secondary mitral regurgitation (SMR) do not receive guideline-directed medical therapy (GDMT) for heart failure (HF). We investigated the association between the use of GDMT and mortality in patients with SMR who underwent transcatheter edge-to-edge repair (TEER).

Methods We retrospectively analysed patients with SMR and a left ventricular ejection fraction of <50% who underwent TEER at three centres. According to current HF guidelines, GDMT was defined as triple therapy consisting of beta-blockers, renin–angiotensin system (RAS) inhibitors and mineralocorticoid receptor antagonists (MRAs). Patients were divided into two groups: GDMT and non-GDMT groups. We calculated the propensity scores and carried out inverse probability of treatment weighting (IPTW) analyses to compare 2-year mortality between the two groups.

Results Of 463 patients, 228 (49.2%) were treated with GDMT upon discharge. IPTW-adjusted Kaplan-Meier curve showed patients with GDMT had a lower incidence of mortality than those without GDMT (19.8% vs 31.1%, p=0.011). In IPTW-adjusted Cox proportional hazards analysis, GDMT was associated with a reduced risk of 2-year mortality (HR: 0.58; 95% CI: 0.35 to 0.95; p=0.030), which was consistent among clinical subgroups. Moreover, patients with GDMT had a higher rate of left ventricular reverse remodelling at 1 year after TEER than those without GDMT.

Conclusion GDMT, defined as triple therapy consisting of beta-blockers, RAS inhibitors and MRAs, was associated with a reduced risk of 2-year mortality after TEER for SMR. Optimisation of medical therapy is crucial to improve clinical outcomes in patients undergoing TEER for SMR.

  • Mitral Valve Insufficiency

Data availability statement

Data are available upon reasonable request.

Statistics from Altmetric.com

Data availability statement

Data are available upon reasonable request.

View Full Text

Footnotes

  • TT and RK are joint first authors.

  • Twitter @TETSUTANAKA5

  • Contributors TT and MUB conceived the study and were responsible for the design of the study. TT performed formal analysis. TT and RK wrote the first draft and revised the manuscript. MS, CI, CM, BMB, PH and CZ were involved in data collection and contributed to manuscript review. AS was involved in manuscript review and editing. MUB, MK, SB, GN, RW and RP were involved in supervision and manuscript review and editing. TT and MUB are guarantors for the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RP has received speaker and consultant honoraria from Abbott and Edwards Lifesciences, outside the submitted work. GN has received research funding from the Deutsche Forschungsgemeinschaft, the German Federal Ministry of Education and Research, the European Union, Abbott, Edwards Lifesciences, Medtronic and St Jude Medical; and has honoraria for lectures or advisory boards from Abbott, Edwards Lifesciences, Medtronic and St Jude Medical. SB has received lecture honoraria from Edwards Lifesciences, Bayer Vital, CVRx, MSD Sharp&Dome, JenaValve Technology and Abbott; and research grants from IcoVifor, Symetis SA, Pfizer, JenaValve Technology, Valtech, OptumInsight, Biotronik and Abbott, outside the submitted work. CI has received travel support from Abbott and speaker and consultant honoraria from Abbott and Edwards Lifesciences, outside the submitted work. TT has been financially supported in part by a fellowship from the Japanese College of Cardiology. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles