%0 Journal Article
%T Guideline-Directed Medical Therapy and Survival After TEER for Secondary Mitral Regurgitation With Right Ventricular Impairment.
%A Mazzola M
%A Giannini C
%A Adamo M
%A Stolz L
%A Praz F
%A Butter C
%A Pfister R
%A Iliadis C
%A Melica B
%A Sampaio F
%A Kalbacher D
%A Koell B
%A Spieker M
%A Metra M
%A Stephan von Bardeleben R
%A Karam N
%A Kresoja KP
%A Lurz P
%A Petronio AS
%A Hausleiter J
%A De Carlo M
%J JACC Cardiovasc Interv
%V 17
%N 12
%D 2024 Jun 24
%M 38925749
%F 11.075
%R 10.1016/j.jcin.2024.04.025
%X <B>BACKGROUND: </B>Right ventricular impairment is common among patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation (SMR). Adherence to guideline-directed medical therapy (GDMT) for heart failure is poor in these patients.<BR><B>OBJECTIVE: </B>The aim of this study was to evaluate the impact of GDMT on long-term survival in this patient cohort.<BR><B>METHODS: </B>Within the EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) international registry, we selected patients with SMR and right ventricular impairment (tricuspid annular plane systolic excursion ≤17 mm and/or echocardiographic right ventricular-to-pulmonary artery coupling <0.40 mm/mm Hg). Titrated guideline-directed medical therapy (GDMTtit) was defined as a coprescription of 3 drug classes with at least one-half of the target dose at the latest follow-up. The primary outcome was all-cause mortality at 6 years.<BR><B>RESULTS: </B>Among 1,213 patients with SMR and right ventricular impairment, 852 had complete data on medical therapy. The 123 patients who were on GDMTtit showed a significantly higher long-term survival vs the 729 patients not on GDMTtit (61.8% vs 36.0%; P < 0.00001). Propensity score-matched analysis confirmed a significant association between GDMTtit and higher survival (61.0% vs 43.1%; P = 0.018). GDMTtit was an independent predictor of all-cause mortality (HR: 0.61; 95% CI: 0.39-0.93; P = 0.02 for patients on GDMTtit vs those not on GDMTtit). Its association with better outcomes was confirmed among all subgroups analyzed.<BR><B>CONCLUSIONS: </B>In patients with right ventricular impairment undergoing transcatheter edge-to-edge repair for SMR, titration of GDMT to at least one-half of the target dose is associated with a 40% lower risk of all-cause death up to 6 years and should be pursued independent of comorbidities.