Guideline-directed medical therapy assessment in heart failure patients undergoing percutaneous mitral valve repair.
ESC Heart Fail
; 11(3): 1802-1807, 2024 Jun.
Article
en En
| MEDLINE
| ID: mdl-38351672
ABSTRACT
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 ANDRESULTS:
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 < 0.05 for all). The overall GDMT score was associated with all-cause mortality (hazard ratio 0.90, 95% confidence interval 0.86-0.95 for each 1-point increase in the GDMT score). This association remained significant after adjusting for renal function and co-morbidities.CONCLUSIONS:
This study demonstrates the utility of a simple GDMT scoring system for assessing the adequacy of GDMT in HFrEF patients with relevant SMR undergoing M-TEER. The GDMT score has potential applications in guiding the design of future clinical trials and aiding clinical decision-making processes.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Volumen Sistólico
/
Insuficiencia Cardíaca
/
Válvula Mitral
/
Insuficiencia de la Válvula Mitral
Tipo de estudio:
Guideline
/
Prognostic_studies
Límite:
Aged
/
Female
/
Humans
/
Male
Idioma:
En
Revista:
ESC Heart Fail
Año:
2024
Tipo del documento:
Article
País de afiliación:
Alemania