Universität zu Köln

Tanaka, Tetsu ORCID: 0000-0003-0780-8689, Kavsur, Refik, Spieker, Maximilian, Iliadis, Christos, Metze, Clemens, Brachtendorf, Birthe M., Horn, Patrick, Zachoval, Christian, Sugiura, Atsushi, Kelm, Malte ORCID: 0000-0003-0060-1052, Baldus, Stephan, Nickenig, Georg, Westenfeld, Ralf, Pfister, Roman and Becher, Marc Ulrich (2022). Guideline-directed medical therapy after transcatheter edge-to-edge mitral valve repair. Heart, 108 (21). S. 1722 - 1729. LONDON: BMJ PUBLISHING GROUP. ISSN 1468-201X

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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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Tanaka, Tetsu UNSPECIFIED orcid.org/0000-0003-0780-8689 UNSPECIFIED Kavsur, Refik UNSPECIFIED UNSPECIFIED UNSPECIFIED Spieker, Maximilian UNSPECIFIED UNSPECIFIED UNSPECIFIED Iliadis, Christos UNSPECIFIED UNSPECIFIED UNSPECIFIED Metze, Clemens UNSPECIFIED UNSPECIFIED UNSPECIFIED Brachtendorf, Birthe M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Horn, Patrick UNSPECIFIED UNSPECIFIED UNSPECIFIED Zachoval, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Sugiura, Atsushi UNSPECIFIED UNSPECIFIED UNSPECIFIED Kelm, Malte UNSPECIFIED orcid.org/0000-0003-0060-1052 UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Nickenig, Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED Westenfeld, Ralf UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfister, Roman UNSPECIFIED UNSPECIFIED UNSPECIFIED Becher, Marc Ulrich UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-680738
DOI:	10.1136/heartjnl-2022-320826
Journal or Publication Title:	Heart
Volume:	108
Number:	21
Page Range:	S. 1722 - 1729
Date:	2022
Publisher:	BMJ PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	1468-201X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language HEART-FAILURE; EJECTION FRACTION; REGURGITATION; OUTCOMES; PROGNOSIS; EFFICACY Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/68073