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Effective Regurgitant Orifice Area and Left Ventricular Volume Impact on Hospitalizations Effects of Transcatheter Edge-to-Edge Mitral Valve Repair: A Meta-Regression Analysis
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 19 - DOENÇA VALVULAR
Speaker:
Barbara Lage Garcia
Congress:
CPC 2025
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Bárbara Lage Garcia; Emídio Mata; Margarida Castro; Luísa Pinheiro; Mariana Tinoco; João Português; Francisco Ferreira; Sílvia Ribeiro; Lucy Calvo; António Lourenço
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="color:black">Background:</span></span></span></p> <div style="text-align:justify"><span style="font-size:16px">The impact of transcatheter edge-to-edge mitral valve repair (MTEER) on reducing hospitalizations in patients with secondary mitral regurgitation (SMR) remains a topic of debate.</span><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="color:black"><span style="font-size:14px"> </span>This meta-regression evaluates how baseline effective regurgitant orifice area (EROA) and left ventricular end-diastolic volume (LVEDV) influence hospitalization effects of MTEER when compared to guideline-directed medical therapy (GDMT).</span></span></span></div> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="color:black">Methods:</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">In September 2024, a systematic search was performed in PubMed, the Cochrane Central Register of Controlled Trials, Scopus, and Web of Science to identify <span style="color:black">randomized controlled trials (RCTs) </span>involving patients with SMR randomized to either MTEER plus GDMT or GDMT alone and reporting <span style="color:black">hazard ratios (HR)</span> for hospitalizations. HRs between the two groups for all hospitalizations (first and recurrent) at 24 months were pooled using a mixed-effects meta-regression model (DerSimonian-Laird) <span style="color:black">with EROA and LVEDV as moderators.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="color:black">Results:</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="color:black">From 1558 identified articles, the final analysis included the COAPT, MITRA-FR, and RESHAPE-HF2 trials with a total of 1423 patients. </span>Meta-regression revealed a baseline HR for 24-month all hospitalizations for a patient with an EROA of 0.2 cm² of 0.758 [95% CI: 0.359–1.600], with an increase by a factor of 0.873 [95% CI: 0.508–1.501] per 0.1 cm² increase in EROA. Baseline EROA did not influence the outcome significantly (p = 0.622), having a pseudo-R² of -2.09, indicating no improvement in model fit. As for a baseline LVEDV impact, a baseline HR for 24-month all hospitalizations for a reference LVEDV of 180 mL estimated at 0.500 [0.374–0.668], with a borderline non-significant increase by a factor of 1.077 [0.994–1.166] per additional 10 mL (p = 0.0687, pseudo-R² = 1.00).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="color:black">Discussion:</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">This meta-regression found no significant effect of baseline EROA on hospitalization outcomes for SMR patients undergoing MTEER. However, a borderline trend suggested that larger baseline LVEDV may be associated with a higher risk of hospitalization. These findings highlight the complexity of predicting hospitalization outcomes after MTEER and suggest that baseline LVEDV may be more relevant than EROA in determining MTEER benefits in SMR. Nevertheless, the limited dataset raises concerns about the robustness of these conclusions.</span></span></p>
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