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Optimizing heart failure medical therapy in secondary mitral regurgitation patients undergoing transcatheter edge-to-edge repair
Session:
Posters (Sessão 5 - Écran 2) - Insuficiência cardíaca - tratamento farmacológico
Speaker:
Diogo Santos Ferreira
Congress:
CPC 2023
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Diogo Santos Ferreira; Silvia Diaz; Cláudio Guerreiro; Mariana Brandão; Rafael Teixeira; Fábio Nunes; Francisca Saraiva; Eulália Pereira; Francisco Sampaio; Lino Santos; Alberto Rodrigues; Pedro Braga; Gustavo Pires-Morais; Bruno Melica; Ricardo Fontes-Carvalho
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">BACKGROUND: Severe secondary mitral regurgitation (SMR) aggravates prognosis in heart failure (HF) patients. Transcatheter edge-to-edge repair (TEER) should be considered in selected SMR patients, resulting in a reduction of mortality and HF hospitalization. Moreover, TEER in these patients may allow a hemodynamic improvement, with subsequent better tolerance to guideline-directed HF medical therapy and potential additional survival benefit.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">PURPOSE: Characterize the use of prognosis-modifying drugs in HF patients before and after TEER for SMR and explore its associations with mortality after intervention.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">METHODS: A single-centre retrospective database of all TEER performed for SMR between 2014 and 2021 was consulted. Primary endpoint was defined as all-cause mortality over the 5-years follow-up. The use of renin-angiotensin-inhibitors (RASI), neprilysin inhibitors (ARNI), beta-blockers (BB), mineralocorticoid antagonists (MRA) and furosemide were compared between pre-intervention and over follow-up using McNemar test, as well as the use of triple therapy (RASI/ARNI+BB+MRA). Survival of patients with or without triple therapy after TEER was compared using Kaplan-Meier curves, log-rank test and Cox proportional hazard model adjusted for EuroSCORE II.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">RESULTS: Eighty-four patients underwent TEER for SMR over the period defined (mean age 73 years-old), with a predominance of male patients (64%), with a mean ejection fraction of 36.9±10.5%. After TEER, there was a statistically significant increase in use of MRA (46% to 63%, p=0.008) and, consequently, triple therapy (27% to 40%, p=0.035), while use of RASI, BB, ARNI and furosemide was no different (72% to 69%, p=0.79; 76% to 82%, p=0.34; 8.8% to 5.9%, p=0.75; 94% to 97%, p=0.63; respectively), as well as dose of furosemide (82 to 81mg). Use of triple therapy after TEER tended to be associated with better survival, though not reaching statistical significance [hazard ratio (HR) 0.53 (0.26-1.08), p=0.082]. In the multivariate analysis, neither triple therapy nor EuroSCORE II were associated with worse survival after TEER (p=0.2 for both).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">CONCLUSIONS: Use of optimal medical therapy in HF patients with SMR remains suboptimal. However, after-TEER status was associated with a more frequent use of some guideline-recommended drugs, namely MRA, allowing a higher percentage of patients to be under triple therapy. Although there was a trend towards better survival with the use of triple therapy after TEER, it did not reach statistical significance.</span></span></p>
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