Heart failure & cardiomyopathies
Impact of Transcatheter Edge-to-Edge Mitral Valve Repair on Guideline-Directed Medical Therapy Uptitration
Authors' conclusion
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.
Study context
- Population
- Patients with secondary MR and HFrEF undergoing M-TEERof 1,641 EuroSMR patients
- Participants
- 810 patients
- Exposure
- Guideline-directed medical therapy (GDMT) uptitration vs no GDMT uptitration after M-TEER
- GDMT uptitrationn = 307
- Outcome
- All-cause death; composite of all-cause death or heart failure (HF) hospitalization
Methodological detailsEuroSMR Registry
- EuroSMR Registry
Main finding
As reported in the abstract
GDMT uptitration vs No uptitrationAdjusted hazard ratio (95% CI)P value
All-cause death
0.62(0.41–0.93)
P = 0.020All-cause death or HF hospitalization
0.54(0.38–0.76)
P < 0.001Observational data: associations, not effects.
Further findings
Predictor of GDMT uptitration after M-TEER · baseline to 6-month follow-up
| Adjusted OR (95% CI) | P value | ||
|---|---|---|---|
| Degree of MR reductionIndependent predictor | 1.71 (1.08–2.71) | P = 0.022 | |
| 0.20.5125Adjusted odds ratio (log scale) |
GDMT uptitration after M-TEER
- GDMT uptitration occurred
- 307 patients (38%)
Proportion receiving ACEi/ARB/ARNI, beta-blockers, MRA · before vs 6 months after M-TEER
- ACEi/ARB/ARNI: before vs 6 months after M-TEER
- 78% vs 84%
- Beta-blockers: before vs 6 months after M-TEER
- 89% vs 91%
- MRA: before vs 6 months after M-TEER
- 62% vs 66%
- All P < 0.001
Original publication
Impact of Transcatheter Edge-to-Edge Mitral Valve Repair on Guideline-Directed Medical Therapy Uptitration. JACC Cardiovasc Interv. Published 22 March 2023. doi:10.
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