RT Journal Article
SR Electronic
T1 Guideline-directed medical therapy after transcatheter edge-to-edge mitral valve repair
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP heartjnl-2022-320826
DO 10.1136/heartjnl-2022-320826
A1 Tetsu Tanaka
A1 Refik Kavsur
A1 Maximilian Spieker
A1 Christos Iliadis
A1 Clemens Metze
A1 Birthe M Brachtendorf
A1 Patrick Horn
A1 Christian Zachoval
A1 Atsushi Sugiura
A1 Malte Kelm
A1 Stephan Baldus
A1 Georg Nickenig
A1 Ralf Westenfeld
A1 Roman Pfister
A1 Marc Ulrich Becher
YR 2022
UL http://heart.bmj.com/content/early/2022/06/07/heartjnl-2022-320826.abstract
AB 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.Data are available upon reasonable request.