European journal of heart failure · 2026
Clinical impact of early changes in guideline-directed medical therapy after mitral valve transcatheter edge-to-edge repair.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Yoshida Ayano, Yamamoto Masanori, Nakazawa Gaku, Mizutani Kazuki, Yamada Nobuhiro, Soejima Naoko, Kawamura Takayuki, Matsuzoe Hiroki, Miyoshi Tatsuya, Saji Mike, Kubo Shunsuke, Asami Masahiko, Enta Yusuke, Shirai Shinichi, Izumo Masaki, Mizuno Shingo, Watanabe Yusuke, Amaki Makoto, Kodama Kazuhisa, Otsuki Hisao, Naganuma Toru, Bota Hiroki, Ohno Yohei, Yamawaki Masahiro, Ueno Hiroshi, Hachinohe Daisuke, Izumi Yuki, Shimura Tetsuro, Sugiura Atsushi, Otsuka Toshiaki, Hayashida Kentaro
Аннотация
BACKGROUND AND AIMS: Mitral transcatheter edge-to-edge repair (M-TEER) is an established therapy for functional mitral regurgitation (FMR) and reduced left ventricular ejection fraction (LVEF). Although guideline-directed medical therapy (GDMT) is ideally optimized before M-TEER, this procedure may facilitate early post-procedural GDMT changes. However, the clinical impact of early in-hospital GDMT modifications remains unclear.
METHODS: We analysed 1638 patients with FMR and LVEF <50% enrolled in a multicentre Japanese registry. The patients were stratified according to the number of GDMT classes prescribed at discharge (single [n = 183]; double [n = 505]; triple [n = 630]; quadruple [n = 320]). Changes from before M-TEER to discharge were categorized as increased (n = 271), unchanged (n = 1219), or decreased (n = 148). Associations between GDMT patterns and subsequent outcomes were evaluated. The primary endpoint was a composite of all-cause mortality and heart failure rehospitalization at 1 year.
RESULTS: Primary endpoints were achieved in 357 patients (22%). Event rates decreased across groups (single, 32%; double, 24%; triple, 21%; quadruple, 14%; P < 0.001). After adjusting for confounders, a greater number of GDMT classes at discharge independently predicted better prognosis (hazard ratio [HR]: 0.83; 95% confidence interval [CI]: 0.73-0.95), whereas pre-M-TEER GDMT was not significant. Compared with decreased GDMT, an unchanged status was not associated with improved outcomes, while an increased status significantly improved prognosis (HR 0.62, 95% CI 0.39-0.99).
CONCLUSION: In patients with FMR and LVEF <50%, a higher number of GDMT classes at discharge and in-hospital uptitration of the GDMT class were associated with better outcomes, suggesting that early post-procedural GDMT optimization warrants further investigation.
METHODS: We analysed 1638 patients with FMR and LVEF <50% enrolled in a multicentre Japanese registry. The patients were stratified according to the number of GDMT classes prescribed at discharge (single [n = 183]; double [n = 505]; triple [n = 630]; quadruple [n = 320]). Changes from before M-TEER to discharge were categorized as increased (n = 271), unchanged (n = 1219), or decreased (n = 148). Associations between GDMT patterns and subsequent outcomes were evaluated. The primary endpoint was a composite of all-cause mortality and heart failure rehospitalization at 1 year.
RESULTS: Primary endpoints were achieved in 357 patients (22%). Event rates decreased across groups (single, 32%; double, 24%; triple, 21%; quadruple, 14%; P < 0.001). After adjusting for confounders, a greater number of GDMT classes at discharge independently predicted better prognosis (hazard ratio [HR]: 0.83; 95% confidence interval [CI]: 0.73-0.95), whereas pre-M-TEER GDMT was not significant. Compared with decreased GDMT, an unchanged status was not associated with improved outcomes, while an increased status significantly improved prognosis (HR 0.62, 95% CI 0.39-0.99).
CONCLUSION: In patients with FMR and LVEF <50%, a higher number of GDMT classes at discharge and in-hospital uptitration of the GDMT class were associated with better outcomes, suggesting that early post-procedural GDMT optimization warrants further investigation.