Modifications of medical treatment and outcome after percutaneous correction of secondary mitral regurgitation

ESC Heart Failure

Giulia Barbati¹  Claudio Rapezzi²  Thomas Caiffa³  Marco Merlo³  Gianfranco Sinagra³  Andrea Perkan³  Davide Stolfo³  Renata Korcova³  Matteo Castrichini³  Giancarlo Vitrella³  Antonio De Luca³  Alessandra Berardini⁴  Marco Foroni⁴  Elena Biagini⁴  Miriam Compagnone⁴  Francesco Saia⁴ 

[1] Biostatistics Unit, Department of Medical Sciences University of Trieste Trieste Italy;Cardiovascular Center University of Ferrara Ferrara Italy;Division of Cardiology, Cardiothoracovascular Department Azienda Sanitaria Universitaria Giuliano Isontina Trieste Italy;Institute of Cardiology University Hospital “S. Orsola‐Malpighi” Bologna Italy;

关键词: Reduced ejection fraction heart failure;    Mitral regurgitation;    Guideline‐directed medical therapy;    Percutaneous mitral valve repair;   

DOI  :  10.1002/ehf2.12737

来源: DOAJ

【 摘 要 】

Abstract Aims The optimization of guideline‐directed medical therapy (GDMT) in reduced ejection fraction heart failure (HFrEF) is associated with improved survival and can reduce the severity of secondary mitral regurgitation (SMR). Highest tolerated doses should be achieved before percutaneous mitral valve repair (pMVR) and drugs titration further pursued after procedure. The degree of GDMT titration in patients with HFrEF and SMR treated with pMVR remains unexplored. We sought to evaluate the adherence to GDMT in HFrEF in patients undergoing pMVR and to explore the association between changes in GDMT post‐pMVR and prognosis. Methods and results We included all the patients with HFrEF and SMR ≥ 3 + treated with pMVR between 2012 and 2019 and with available follow‐up. GDMT, comprehensive of dosages, was systematically recorded. The study endpoint was a composite of death and heart transplantation. Among 133 patients successfully treated, 121 were included (67 ± 12 years old, 77% male patients). Treatment rates of angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor neprilysin inhibitor (ACEIs/ARBs/ARNI), beta‐blockers, and mineralcorticoid receptor antagonist at baseline and follow‐up were 73% and 79%, 85% and 84%, 70% and 70%, respectively. At baseline, 33% and 32% of patients were using >50% of the target dose of ACEI/ARB/ARNI and beta‐blockers. At follow‐up (median time 4 months), 33% of patients unchanged, 34% uptitrated, and 33% of patients downtitrated GDMT. Downtitration of GDMT was independently associated with higher risk of death/heart transplantation (hazard ratio: 2.542, 95%confidence interval: 1.377–4.694, P = 0.003). Conclusions Guideline‐directed medical therapy is frequently underdosed in HFrEF patients with SMR undergoing pMVR. Downtitration of medications after procedure is associated with poor prognosis.

【 授权许可】

Unknown