Guideline‐directed medical therapy assessment in heart failure patients undergoing percutaneous mitral valve repair

• Published in: ESC Heart Failure 2024-06, Vol.11 (3), p.1802-1807
• Main Authors: Kresoja, Karl‐Patrik, Adamo, Marianna, Rommel, Karl‐Phillipp, Stolz, Lukas, Karam, Nicole, Giannini, Cristina, Melica, Bruno, Bardeleben, Ralph Stephan, Butter, Christian, Horn, Patrick, Praz, Fabien, Kalbacher, Daniel, Iliadis, Christos, Thiele, Holger, Hausleiter, Jörg, Metra, Marco, Lurz, Philipp
• Format: Article
• Language: English
• Subjects: Aged; Cardiac Catheterization - methods; Clinical trials; Ejection fraction; Enzymes; Female; Follow-Up Studies; Guideline‐directed medical therapy; Heart failure; Heart Failure - physiopathology; Heart Failure - therapy; Heart failure with reduced ejection fraction; Heart Valve Prosthesis Implantation - methods; Hemodynamics; Humans; Male; Missing data; Mitral regurgitation; Mitral Valve - surgery; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; Mortality; Patients; Physicians; Practice Guidelines as Topic; Registries; Short Communication; Short Communications; Stroke Volume - physiology; Treatment Outcome; Ventricular Function, Left - physiology
• ISSN: 2055-5822; 2055-5822
• DOI: 10.1002/ehf2.14705

Aims Achieving optimized guideline‐directed medical therapy (GDMT) is recommended prior to transcatheter mitral valve edge‐to‐edge repair (M‐TEER) for secondary mitral regurgitation (SMR). We aimed to propose and validate an easy‐to‐use score for assessing the quality of GDMT in patients with heart failure with reduced ejection fraction (HFrEF) undergoing M‐TEER. Methods and results Among the 1641 EuroSMR patients enrolled in the EuroSMR Registry who underwent M‐TEER, a total of 1072 patients [median age 74, interquartile range (IQR) 67–79 years, 29% female] had complete data on GDMT and a left ventricular ejection fraction ≤ 40% and were included in the current study. We proposed a GDMT score that considers the dosage levels of three medication classes (angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor‐neprilysin inhibitors, beta‐blockers, and mineralocorticoid receptor antagonists), with a maximum score of 12 points indicating optimal GDMT. The primary outcome was all‐cause mortality. The median GDMT score was 4 points (IQR 3–6). All three domains of the scoring system were associated with all‐cause mortality (P