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Impact of Transcatheter Edge-to-Edge Mitral Valve Repair on Guideline-Directed Medical Therapy Uptitration

Data de publicação: Data Ahead of Print:

Autores da FMUP

  • Francisco Pedro Morais Dias De Almeida Sampaio

    Autor

Participantes de fora da FMUP

  • Adamo, Marianna
  • Tomasoni, Daniela
  • Stolz, Lukas
  • Stocker, Thomas J.
  • Pancaldi, Edoardo
  • Koell, Benedikt
  • Karam, Nicole
  • Besler, Christian
  • Giannini, Cristina
  • Praz, Fabien
  • Ruf, Tobias
  • Pechmajou, Louis
  • Baldus, Stephan
  • Neuss, Michael
  • Iliadis, Christos
  • Butter, Christian
  • Kalbacher, Daniel
  • Melica, Bruno
  • Lurz, Philipp
  • Petronio, Anna S.
  • Bardeleben, Ralph Stephan von
  • Windecker, Stephan
  • Butler, Javed
  • Fonarow, Gregg C.
  • Hausleiter, Jorg
  • Metra, Marco

Unidades de investigação

Abstract

BACKGROUND Guideline-directed medical therapy (GDMT) optimization is mandatory before transcatheter edge-to -edge mitral valve repair (M-TEER) in patients with secondary mitral regurgitation (SMR) and heart failure (HF) with reduced ejection fraction (HFrEF). However, the effect of M-TEER on GDMT is unknown. OBJECTIVES The authors sought to evaluate frequency, prognostic implications and predictors of GDMT uptitration after M-TEER in patients with SMR and HFrEF. METHODS This is a retrospective analysis of prospectively collected data from the EuroSMR Registry. The primary events were all-cause death and the composite of all-cause death or HF hospitalization. RESULTS Among the 1,641 EuroSMR patients, 810 had full datasets regarding GDMT and were included in this study. GDMT uptitration occurred in 307 patients (38%) after M-TEER. Proportion of patients receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors, beta-blockers, and mineral-ocorticoid receptor antagonists was 78%, 89%, and 62% before M-TEER and 84%, 91%, and 66% 6 months after M-TEER (all P < 0.001). Patients with GDMT uptitration had a lower risk of all-cause death (adjusted HR: 0.62; 95% CI: 0.41-0.93; P = 0.020) and of all-cause death or HF hospitalization (adjusted HR: 0.54; 95% CI: 0.38-0.76; P < 0.001) compared with those without. Degree of MR reduction between baseline and 6-month follow-up was an independent predictor of GDMT uptitration after M-TEER (adjusted OR: 1.71; 95% CI: 1.08-2.71; P = 0.022). CONCLUSIONS GDMT uptitration after M-TEER occurred in a considerable proportion of patients with SMR and HFrEF and is independently associated with lower rates for mortality and HF hospitalizations. A greater decrease in MR was associated with increased likelihood for GDMT uptitration. (J Am Coll Cardiol Intv 2023;16:896-905) (c) 2023 by the American College of Cardiology Foundation.

Dados da publicação

ISSN/ISSNe:
1876-7605, 1936-8798

JACC-CARDIOVASCULAR INTERVENTIONS  Elsevier Inc.

Tipo:
Article
Páginas:
896-905
Link para outro recurso:
www.scopus.com

Citações Recebidas na Web of Science: 24

Citações Recebidas na Scopus: 27

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Keywords

  • guideline-directed medical; therapy; transcatheter edge-to-edge mitral valve repair; treatment optimization

Campos de estudo

Proyectos asociados

Impacto dos acessos femorais guiados por ecografia vs fluoroscopia nas complicações vasculares associadas à implantação de válvula aórtica percutânea

Investigador Principal: Francisco Pedro Morais Dias de Almeida Sampaio

Estudo Clínico Académico . 2021

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