Guideline‐directed medical therapy in patients undergoing transcatheter edge‐to‐edge repair for secondary mitral regurgitation
Satoshi Higuchi, Mathias Orban, Marianna Adamo, Cristina Giannini, Bruno Melica, Nicole Karam, Fabien Praz, Daniel Kalbacher, Benedikt Koell, Lukas Stolz, Daniel Braun, Michael Näbauer, Mirjam G. Wild, Philipp M. Doldi, Michael Neuß, Christian Butter, Mohammad Kassar, T. Ruf, Aniela Petrescu, Sebastian Ludwig, Roman Pfister, Christos Iliadis, Matthias Unterhuber, Francisco Sampaio, Diogo Santos‐Ferreira, Hölger Thiele, Stephan Baldus, Ralph Stephan von Bardeleben, Steffen Maßberg, Stephan Windecker, Philipp Lurz, Anna Sonia Petronio, JoAnn Lindenfeld, William T. Abraham, Marco Metra, Jörg Hausleiter, EuroSMR Investigators
Abstract
AIMS: Guideline-directed medical therapy (GDMT), based on the combination of beta-blockers (BB), renin-angiotensin system inhibitors (RASI), and mineralocorticoid receptor antagonists (MRA), is known to have a major impact on the outcome of patients with heart failure with reduced ejection fraction (HFrEF). Although GDMT is recommended prior to mitral valve transcatheter edge-to-edge repair (M-TEER), not all patients tolerate it. We studied the association of GDMT prescription with survival in HFrEF patients undergoing M-TEER for secondary mitral regurgitation (SMR). METHODS AND RESULTS: EuroSMR, a European multicentre registry, included SMR patients with left ventricular ejection fraction <50%. The outcome was 2-year all-cause mortality. Of 1344 patients, BB, RASI, and MRA were prescribed in 1169 (87%), 1012 (75%), and 765 (57%) patients at the time of M-TEER, respectively. Triple GDMT prescription was associated with a lower 2-year all-cause mortality compared to non-triple GDMT (hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.60-0.91). The association persisted in patients with glomerular filtration rate <30 ml/min, ischaemic aetiology, or right ventricular dysfunction. Further, a positive impact of triple GDMT prescription on survival was observed in patients with residual mitral regurgitation of ≥2+ (HR 0.62; 95% CI 0.44-0.86), but not in patients with residual mitral regurgitation of ≤1+ (HR 0.83; 95% CI 0.64-1.08). CONCLUSION: Triple GDMT prescription is associated with higher 2-year survival after M-TEER in HFrEF patients with SMR. This association was consistent also in patients with major comorbidities or non-optimal results after M-TEER.