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

被引：36

作者：

Adamo, Marianna ^{[1
,2
]}

Tomasoni, Daniela ^{[1
,2
]}

Stolz, Lukas ^{[3
]}

Stocker, Thomas J. ^{[3
]}

Pancaldi, Edoardo ^{[1
,2
]}

Koell, Benedikt ^{[4
]}

Karam, Nicole ^{[5
,6
]}

Besler, Christian ^{[7
]}

Giannini, Cristina ^{[8
]}

Sampaio, Francisco ^{[9
]}

Praz, Fabien ^{[10
]}

Ruf, Tobias ^{[11
]}

Pechmajou, Louis ^{[5
,6
]}

Baldus, Stephan

Neuss, Michael ^{[12
]}

Iliadis, Christos ^{[13
]}

Butter, Christian ^{[13
]}

Kalbacher, Daniel

Melica, Bruno

Lurz, Philipp

Petronio, Anna S.

Bardeleben, Ralph Stephan von ^{[11
]}

Windecker, Stephan

Butler, Javed ^{[14
]}

Fonarow, Gregg C. ^{[15
]}

Hausleiter, Jorg ^{[3
]}

Metra, Marco ^{[1
,2
,16
]}

机构：

[1] Univ Brescia, ASST Spedali Civili, Cardiac Catheterizat Lab & Cardiol, Brescia, Italy

[2] Univ Brescia, Dept Med & Surg Specialties, Radiol Sci & Publ Hlth, Brescia, Italy

[3] Klinikum Univ Munchen, Med Klin & Poliklin 1, Munich, Germany

[4] Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Dept Cardiol, Hamburg, Germany

[5] Hop Europeen Georges Pompidou, Dept Cardiol, Paris, France

[6] INSERM, Paris Cardiovasc Res Ctr, U970, Paris, France

[7] Univ Leipzig, Dept Cardiol, Heart Ctr Leipzig, Leipzig, Germany

[8] Univ Pisa, Cardiothorac & Vasc Dept, Cardiac Catheterizat Lab, Pisa, Italy

[9] Ctr Hosp Vila Nova de Gaia, EspinhoEspinho, Portugal

[10] Inselspital Bern, Univ Klin Kardiol, Bern, Switzerland

[11] Johannes Gutenberg Univ Mainz, Zentrum Kardiol, Mainz, Germany

[12] Brandenburg Med Sch Theodor Fontane, Immanuel Heart Ctr Bernau, Cardiol, Bernau, Germany

[13] Univ Hosp Cologne, Heart Ctr, Hosp Ctr, Dept Cardiol, Cologne, Germany

[14] Univ Mississippi, Dept Med, Jackson, MS USA

[15] Univ Calif Los Angeles, Div Cardiol, David Geffen Sch Med, Los Angeles, CA USA

[16] Univ Brescia, Inst Cardiol, Dept Med & Surg Specialties Radiol Sci & Publ Hlth, Piazzale Spedali Civili 1, I-25123 Brescia, Italy

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2023年 / 16卷 / 08期

关键词：

guideline-directed medical; therapy; transcatheter edge-to-edge mitral valve repair; treatment optimization; HEART-FAILURE; REGURGITATION; OUTCOMES; IMPROVEMENT;

D O I：

10.1016/j.jcin.2023.01.362

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：896 / 905

页数：10

共 35 条

[1] COAPT-Like Profile Predicts Long-Term Outcomes in Patients With Secondary Mitral Regurgitation Undergoing MitraClip Implantation [J].

Adamo, Marianna ;

Fiorelli, Francesca ;

Melica, Bruno ;

D'Ortona, Renzo ;

Lupi, Laura ;

Giannini, Cristina ;

Silva, Gualter ;

Fiorina, Claudia ;

Branca, Luca ;

Chiari, Ermanna ;

Chizzola, Giuliano ;

Spontoni, Paolo ;

Guerreiro, Claudio Espada ;

Curello, Salvatore ;

Petronio, Anna Sonia ;

Metra, Marco .

JACC-CARDIOVASCULAR INTERVENTIONS, 2021, 14 (01) :15-25

[2] Impact of disproportionate secondary mitral regurgitation in patients undergoing edge-to-edge percutaneous mitral valve repair [J].

Adamo, Marianna ;

Cani, Dario Salvatore ;

Gavazzoni, Mara ;

Taramasso, Maurizio ;

Lupi, Laura ;

Fiorelli, Francesca ;

Giannini, Cristina ;

Branca, Luca ;

Zuber, Michel ;

Curello, Salvatore ;

Petronio, Anna Sonia ;

Maisano, Francesco ;

Metra, Marco .

EUROINTERVENTION, 2020, 16 (05) :413-+

[3] Five-year clinical outcomes after percutaneous edge-to-edge mitral valve repair: Insights from the multicenter GRASP-IT registry [J].

Adamo, Marianna ;

Grasso, Carmelo ;

Capodanno, Davide ;

Rubbio, Antonio Popolo ;

Scandura, Salvatore ;

Giannini, Cristina ;

Fiorelli, Francesca ;

Fiorina, Claudia ;

Branca, Luca ;

Brambilla, Nedy ;

Bedogni, Francesco ;

Petronio, Anna Sonia ;

Curella, Salvatore ;

Tamburino, Corrado .

AMERICAN HEART JOURNAL, 2019, 217 :32-41

[4] Use of cardiac resynchronization therapy to optimize beta-blocker therapy in patients with heart failure and prolonged QRS duration [J].

Aranda, JM ;

Woo, GW ;

Conti, JB ;

Schofield, RS ;

Conti, CR ;

Hill, JA .

AMERICAN JOURNAL OF CARDIOLOGY, 2005, 95 (07) :889-891

[5] Effect of Losartan on Mitral Valve Changes After Myocardial Infarction [J].

Bartko, Philipp E. ;

Dal-Bianco, Jacob P. ;

Guerrero, J. Luis ;

Beaudoin, Jonathan ;

Szymanski, Catherine ;

Kim, Dae-Hee ;

Seybolt, Margo M. ;

Handschumacher, Mark D. ;

Sullivan, Suzanne ;

Garcia, Michael L. ;

Titus, James S. ;

Wylie-Sears, Jill ;

Irvin, Whitney S. ;

Messas, Emmanuel ;

Hagege, Albert A. ;

Carpentier, Alain ;

Aikawa, Elena ;

Bischoff, Joyce ;

Levine, Robert A. .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2017, 70 (10) :1232-1244

[6] 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 [J].

Bedogni, Francesco ;

Rubbio, Antonio Popolo ;

Grasso, Carmelo ;

Adamo, Marianna ;

Denti, Paolo ;

Giordano, Arturo ;

Tusa, Maurizio ;

Bianchi, Giovanni ;

De Marco, Federico ;

Bartorelli, Antonio L. ;

Montorfano, Matteo ;

Godino, Cosmo ;

Citro, Rodolfo ;

De Felice, Francesco ;

Mongiardo, Annalisa ;

Monteforte, Ida ;

Villa, Emmanuel ;

Giannini, Cristina ;

Crimi, Gabriele ;

Tarantini, Giuseppe ;

Testa, Luca ;

Tamburino, Corrado .

EUROPEAN JOURNAL OF HEART FAILURE, 2021, 23 (08) :1364-1376

[7] β-blockade therapy in chronic heart failure:: Diastolic function and mitral regurgitation improvement by carvedilol [J].

Capomolla, S ;

Febo, O ;

Gnemmi, M ;

Riccardi, G ;

Opasich, C ;

Caporotondi, A ;

Mortara, A ;

Pinna, G ;

Cobelli, F .

AMERICAN HEART JOURNAL, 2000, 139 (04) :596-608

[8] Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry [J].

Chioncel, Ovidiu ;

Lainscak, Mitja ;

Seferovic, Petar M. ;

Anker, Stefan D. ;

Crespo-Leiro, Maria G. ;

Harjola, Veli-Pekka ;

Parissis, John ;

Laroche, Cecile ;

Piepoli, Massimo Francesco ;

Fonseca, Candida ;

Mebazaa, Alexandre ;

Lund, Lars ;

Ambrosio, Giuseppe A. ;

Coats, Andrew J. ;

Ferrari, Roberto ;

Ruschitzka, Frank ;

Maggioni, Aldo P. ;

Filippatos, Gerasimos .

EUROPEAN JOURNAL OF HEART FAILURE, 2017, 19 (12) :1574-1585

[9] Patient factors associated with titration of medical therapy in patients with heart failure with reduced ejection fraction: data from the QUALIFY international registry [J].

Cowie, Martin R. ;

Schoepe, Jakob ;

Wagenpfeil, Stefan ;

Tavazzi, Luigi ;

Boehm, Michael ;

Ponikowski, Piotr ;

Anker, Stefan D. ;

Filippatos, Gerasimos S. ;

Komajda, Michel .

ESC HEART FAILURE, 2021, 8 (02) :861-871

[10] Two-year cardiac mortality after MitraClip treatment of functional mitral regurgitation in ischemic and non-ischemic dilated cardiomyopathy [J].

Godino, Cosmo ;

Scotti, Andrea ;

Taramasso, Maurizio ;

Adamo, Marianna ;

Russo, Marco ;

Chiarito, Mauro ;

Melillo, Francesco ;

Beneduce, Alessandro ;

Pivato, Carlo Andrea ;

Arrigoni, Luca ;

Toscano, Evelina ;

Salerno, Anna ;

Cappelletti, Alberto ;

Magni, Valeria ;

Stella, Stefano ;

Fragasso, Gabriele ;

Montorfano, Matteo ;

Agricola, Eustachio ;

Ettori, Federica ;

Margonato, Alberto ;

Maisano, Francesco ;

Colombo, Antonio .

INTERNATIONAL JOURNAL OF CARDIOLOGY, 2018, 269 :33-39

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