Effect of post‐procedural evidence‐based therapy on 2‐year prognosis after transcatheter mitral valve repair

Hagnäs, Magnus J; Grasso, Carmelo; Salvo, M.; Sardone, Andrea; P, Rapisarda; Pelliccia, Matteo; Dipasquale, Francesco; Castania, Giuseppe; Mangiafico, Sarah; Capranzano, Piera; Barbanti, Marco; Denaro, A.; Scandura, Salvatore; Mäkikallio, Timo H.; Capodanno, Davide; Tamburino, Corrado

doi:10.1002/ejhf.2002

Cited by 2 publications

(3 citation statements)

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“…Nevertheless, there is still a sizeable proportion of patients with SMR who do not receive optimal medical therapy in clinical practice, due to age, blood pressure, renal function and comorbidities 6 7. In the present cohort, approximately half of patients undergoing TEER for SMR were not treated with GDMT upon discharge, which was comparable with the COAPT trial and other previous studies 4 6 7 15. Nevertheless, it has been little known about the clinical relevance of GDMT after TEER.…”

Section: Discussionsupporting

confidence: 73%

Guideline-directed medical therapy after transcatheter edge-to-edge mitral valve repair

Tanaka

Kavsur

Spieker

et al. 2022

Heart

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ObjectiveA 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).MethodsWe 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.ResultsOf 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.ConclusionGDMT, 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.

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Section: Discussionsupporting

confidence: 73%

Guideline-directed medical therapy after transcatheter edge-to-edge mitral valve repair

Tanaka

Kavsur

Spieker

et al. 2022

Heart

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“…However, it emerged that the overall population was treated mostly with beta‐blocker and furosemide. Underuse of or non‐adherence to optimal medical therapy in the real‐world setting of patients with MR and HF undergoing the MitraClip procedure have been previously reported 17 . This finding may be related to several non‐predictable factors, including haemodynamic intolerance, electrolyte disorders, and chronic kidney disease, which make the achievement of target doses of multi‐combination therapy in elderly, comorbid patients challenging.…”

Section: Discussionmentioning

confidence: 99%

“…The lower use of first‐line HF drugs (angiotensin‐converting enzyme inhibitor, angiotensin receptor blocker, angiotensin receptor–neprilysin inhibitor, or mineralocorticoid receptor antagonists), with a recognized prognostic effect, could have a considerable impact also on post‐procedural outcome, stressing for the future the importance of medical therapy optimization according to patient tolerance 17 …”

Section: Discussionmentioning

confidence: 99%

Italian Society of Interventional Cardiology (GIse) registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO): impact of valve disease aetiology and residual mitral regurgitation after MitraClip implantation

Bedogni

Rubbio

Grasso

et al. 2021

European J of Heart Fail

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Aims The Italian Society of Interventional Cardiology (GIse) registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO) was conceived in order to assess the safety and efficacy of MitraClip therapy in Italy. The aim of this study was to assess procedural and mid‐term outcomes, and clinical and echocardiographic predictors of mid‐term mortality after MitraClip therapy, stratifying the results according to the diagnosis of functional and degenerative mitral regurgitation (FMR vs. DMR). Methods and results Between January 2016 and March 2020, 1659 patients were prospectively included in the GIOTTO registry (FMR 59.4% vs. DMR 40.6%). Acute Mitral Valve Academic Research Consortium (MVARC) technical success was achieved in 97.2% of patients, without differences between FMR and DMR and with sustained results at 30 days. In the study population, all‐cause mortality was 4.0%, 17.5% and 34.6% at 30 days, 1 year and 2 years, respectively. Cardiovascular death was the most frequent cause of mortality. Overall hospitalization rates were 6.3%, 23.4% and 31.7% at 30 days, 1 year and 2 years, respectively. The most frequent cause of hospitalization was heart failure, particularly in the first 30 days. FMR and MVARC structural and functional failure were strongly associated with 1‐year mortality. Residual mitral regurgitation 1+ (rMR) was independently related to a reduced risk of 1‐year mortality (hazard ratio 0.62; P = 0.005). Coherently, at 2‐year follow up, FMR was associated with worse outcomes than DMR, and Kaplan–Meier all‐cause mortality was related to rMR. Conclusions Functional mitral regurgitation aetiology affects 1‐year mortality after MitraClip implantation, and differences in mortality and hospitalization rates between FMR and DMR can be observed within 2 years. Optimal rMR 1+ was correlated to a more favourable mid‐term outcome, particularly in FMR.

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Effect of post‐procedural evidence‐based therapy on 2‐year prognosis after transcatheter mitral valve repair

Cited by 2 publications

References 11 publications

Guideline-directed medical therapy after transcatheter edge-to-edge mitral valve repair

Guideline-directed medical therapy after transcatheter edge-to-edge mitral valve repair

Italian Society of Interventional Cardiology (GIse) registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO): impact of valve disease aetiology and residual mitral regurgitation after MitraClip implantation

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