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Impact of Left Ventricular Volume and Effective Regurgitant Orifice Area on Mortality Effects of Transcatheter Edge-to-Edge Mitral Valve Repair: A Meta-Regression Analysis
Session:
SESSÃO DE POSTERS 31 - VALVULOPATIA MITRAL E TRICÚSPIDE - DIAGNÓSTICO E INTERVENÇÃO VALVULAR
Speaker:
Emídio Mata
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Emídio Mata; Bárbara Lage Garcia; Margarida Castro; Luísa Pinheiro; Mariana Tinoco; João Português; Francisco Ferreira; Lucy Calvo; Sílvia Ribeiro; 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> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="color:black">The effectiveness of transcatheter edge-to-edge mitral valve repair (MTEER) in reducing mortality in patients with secondary mitral regurgitation (SMR) remains debated. This meta-regression evaluates how baseline left ventricular end-diastolic volume (LVEDV) and effective regurgitant orifice area (EROA) influence mortality effects of MTEER when compared to guideline-directed medical therapy (GDMT).</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">Methods:</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">On September 2024, PubMed, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science was search for randomized controlled trials (RCTs) of patients with SMR, randomized to MTEER plus GDMT or GDMT alone, reporting on mortality. H</span>azard ratios (HR) between the two groups <span style="color:black">for all-cause mortality at 24 months were pooled using a mixed-effects meta-regression model (DerSimonian-Laird) 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>The pooled mean LVEDV showed a significant effect on HR. Meta-regression revealed a baseline HR of 24-month all-cause mortality for a reference LVEDV of 180 mL of 0.583 [0.429–0.793], with an increase by a factor of 1.076 [1.002–1.157] per additional 10 mL (p = 0.045, pseudo-R² 1.0). As for pooled mean EROA, meta-regression estimated a HR for 24-month all-cause mortality of 0.921 [0.416–2.037] for a patient with an EROA of 0.2 cm², with an increase by a factor of 0.860 [0.484–1.527] per 0.1 cm² increment in EROA. The pseudo-R² was -1.13, and the p-value was 0.606, indicating no significant association.</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><span style="font-size:12.0pt"><span style="font-family:"Aptos",sans-serif">Although baseline EROA did not appear to influence the effects of MTEER on 24-month all-cause mortality, the model demonstrated a significant association between LVEDV and mortality. This finding suggests that MTEER may be significantly more beneficial in patients with less dilated ventricles. However, the perfect fit for LVEDV (pseudo-R² = 1.0) may indicate overfitting, likely due to the small number of included studies (n = 3). Caution is warranted when interpreting these results, as the limited number of trials reduces the robustness of the conclusions. Future studies with larger sample sizes and additional trials are needed to validate the observed relationship between LVEDV and the outcomes of MTEER versus GDMT.</span></span></p>
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