Guideline‐directed medical therapy in patients undergoing transcatheter edge‐to‐edge repair for secondary mitral regurgitation

Higuchi, Satoshi; Orban, Mathias; Adamo, Marianna; Giannini, Cristina; Melica, Bruno; Karam, Nicole; Praz, Fabien; Kalbacher, Daniel; Koell, Benedikt; Stolz, Lukas; Braun, Daniel; Näbauer, Michael; Wild, Mirjam G.; Doldi, Philipp M.; Neuß, Michael; Butter, Christian; Kassar, Mohammad; Ruf, T.; Petrescu, Aniela; Ludwig, Sebastian; Pfister, Roman; Iliadis, Christos; Unterhuber, Matthias; Sampaio, Francisco; Santos-Ferreira, Diogo; Thiele, Holger; Baldus, Stephan; Bardeleben, Ralph Stephan von; Maßberg, Steffen; Windecker, Stephan; Lurz, Philipp; Petronio, Anna Sonia; Lindenfeld, JoAnn; Abraham, William T.; Metra, Marco; Hausleiter, Jörg

doi:10.1002/ejhf.2613

Cited by 16 publications

(16 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, in EuroSMR, a European multicenter registry, including functional MR patients with left ventricular ejection fraction <50% indicated that triple-guideline-directed medical therapies, including MRAs, are associated with better survival after transcatheter edge-to-edge repair [ 21 ]. Therefore, the 2021 European Society of Cardiology as well as the 2022 American Heart Association/American College of Cardiology guidelines confirm the class I indication for mineralocorticoid receptor antagonist in patients with HF and a reduced left ventricular ejection fraction [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…First, given a correlative analysis, this study could not mechanistically provide the direct mechanism linking MRAs and myocardial dysfunction. In addition, the positive effect of Spiro and its high relevance for the treatment of heart failure over furosemide are well-known [ 21 , 22 , 26 ]. However, through this experimental model of MR we highlighted new insights of applications of heart failure drugs in mitigating the progression of MR and the possibilities of clinical interest for further studies.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Mineralocorticoid Receptor Antagonists Mitigate Mitral Regurgitation-Induced Myocardial Dysfunction

Chang

Lin

Chen

et al. 2022

Cells

View full text Add to dashboard Cite

Mitral regurgitation (MR), the disruption of the mitral valve, contributes to heart failure (HF). Under conditions of volume overload, excess mineralocorticoids promote cardiac fibrosis. The mineralocorticoid receptor antagonist spironolactone is a potassium-sparing diuretic and a guideline-recommended therapy for HF, but whether it can ameliorate degenerative MR remains unknown. Herein, we investigate the efficacy of spironolactone in improving cardiac remodeling in MR-induced HF compared with that of a loop diuretic, furosemide. Using a novel and mini-invasive technique, we established a rat model of MR. We treated the rats with spironolactone or furosemide for twelve weeks. The levels of cardiac fibrosis, apoptosis, and stress-associated proteins were then measured. In parallel, we compared the cardiac remodeling of 165 patients with degenerative MR receiving either spironolactone or furosemide. Echocardiography was performed at baseline and at six months. In MR rats treated with spironolactone, left ventricular function—especially when strained—and the pressure volume relationship significantly improved compared to those of rats treated with furosemide. Spironolactone treatment demonstrated significant attenuation of cardiac fibrosis and apoptosis in left ventricular tissue compared to furosemide. Further, spironolactone suppressed the expression of apoptosis-, NADPH oxidase 4 (NOX4)- and inducible nitric oxide synthase (iNOS)-associated proteins. Similarly, compared with MR patients receiving furosemide those prescribed spironolactone demonstrated a trend toward reduction in MR severity and showed improvement in left ventricular function. Collectively, MR-induced cardiovascular dysfunction, including fibrosis and apoptosis, was effectively attenuated by spironolactone treatment. Our findings suggest a potential therapeutic option for degenerative MR-induced HF.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mineralocorticoid Receptor Antagonists Mitigate Mitral Regurgitation-Induced Myocardial Dysfunction

Chang

Lin

Chen

et al. 2022

Cells

View full text Add to dashboard Cite

show abstract

“…Data from the EuroSMR registry showed that among 1344 patients, beta‐blockers, renin–angiotensin system inhibitors, and mineralocorticoid receptor antagonists were prescribed in 1169 (87%), 1012 (75%), and 765 (57%) patients at the time of M‐TEER, respectively. Triple GDMT prescription was associated with a lower 2‐year all‐cause mortality compared to non‐triple GDMT (hazard ratio 0.74; 95% confidence interval 0.60–0.91) 31 …”

Section: Comorbiditiesmentioning

confidence: 96%

“…Triple GDMT prescription was associated with a lower 2-year all-cause mortality compared to non-triple GDMT (hazard ratio 0.74; 95% confidence interval 0.60-0.91). 31 An improvement in right ventricular (RV) function is associated with better outcome among patients with SMR undergoing M-TEER. 32 The short-term changes in tricuspid regurgitation (TR) .…”

Section: Valvular Heart Diseasementioning

confidence: 99%

November 2022 at a glance: focus on epidemiology, prognosis and comorbidities

Tomasoni

Adamo

Metra

2022

European J of Heart Fail

View full text Add to dashboard Cite

The association between cardiometabolic health (CMH) and the risk of heart failure (HF) was assessed in a cohort of 5080 patients with type 2 diabetes (T2D) and without prevalent HF from the Look AHEAD trial. The CMH score included 2 points each for target levels of waist circumference, glomerular filtration rate (GFR), urine albumin-to-creatinine ratio, and 1 point each for blood pressure and glycated haemoglobin at target. Higher baseline CMH score and an improvement in CMH parameters were associated with a lower risk of incident HF. 1 Heart failure with preserved ejection fraction (HFpEF) accounts for more than half of HF hospitalizations. 2 Data regarding 41 708 patients hospitalized for HFpEF were collected between 2017 and 2021 across several centres in China. Patients were often burdened by multiple comorbidities, namely hypertension, atrial fibrillation and coronary artery disease (CAD). At 1-year follow-up, rehospitalization due to HF occurred in 13.6% of patients, while cardiovascular death in 3.1%. 3 The relationship between quality of care as assessed using the European Society of Cardiology (ESC) quality indicators (QIs) and outcome was investigated among 43 704 patients with HF from the Swedish HF registry. 4,5 Out of the 16 QIs, 13 could be measured and 5 were inversely associated with all-cause mortality during follow-up. Quality of care varied across the 80 centres included in the study. 5 BLITZ-HF was a nationwide initiative across 106 Italian centres evaluating the effectiveness of educational intervention to implement guideline-directed medical therapy (GDMT) in HF patients. Overall, 7218 HF patients, with both acute and chronic HF, were enrolled and a web-based pop-up system reminding GDMT recommendations was tested. At baseline, level of adherence to HF guidelines was already elevated. The use of the pop-up system led to a further improvement of six out of nine indicators. 6 Atrial diseaseAtrial function and dynamics play a key role in the development, progression and prognosis of HF. 16,17 Left atrial adverse remodelling (LAAR), defined as an increase in left atrial dimensions on

show abstract

“…Among 1344 patients with LVEF <50% and SMR undergoing M-TEER from a large European registry, the rates of baseline beta blockers, ACEi/ARB/ARNI and MRA prescription were 87%, 75% and 57%, respectively. Triple GDMT prescription was associated with better prognosis after M-TEER 107 . HF phenotypes of advanced disease [i.e.…”

Section: Comorbidities and Special Conditionsmentioning

confidence: 99%

Updates in heart failure: sodium glucose co-transporter 2 inhibitors and beyond – major changes are coming

Cimino

Pancaldi

Tomasoni

et al. 2022

Journal of Cardiovascular Medicine

Self Cite

View full text Add to dashboard Cite

Prevalence of heart failure is increasing worldwide mainly due to the ageing of the population and the improvement in diagnosis and treatment. In recent years, huge progress has been made in the management of heart failure patients. A new definition of chronic heart failure based on left ventricular ejection fraction and its possible trajectories has been reported. New drug classes have been introduced for the treatment of chronic heart failure. In particular, the prognostic benefit of sodium glucose co-transporter 2 inhibitors was demonstrated across all the heart failure phenotypes. Therapies for patients with advanced heart failure (long-term mechanical circulatory supports and heart transplantation) are now indicated also in the case of mild-to-moderate symptoms but with high risk of progression. In patients with acute heart failure, monitoring of urinary sodium and the use of acetazolamide may lead to better decongestion. Importantly, pre- and postdischarge assessment should lead to optimal treatment. Devices and telemonitoring can also be of help. Cardiovascular and noncardiovascular comorbidities are major determinants of the clinical course and need proper management. This review will summarize these important advances.

show abstract

Guideline‐directed medical therapy in patients undergoing transcatheter edge‐to‐edge repair for secondary mitral regurgitation

Cited by 16 publications

References 26 publications

Mineralocorticoid Receptor Antagonists Mitigate Mitral Regurgitation-Induced Myocardial Dysfunction

Mineralocorticoid Receptor Antagonists Mitigate Mitral Regurgitation-Induced Myocardial Dysfunction

November 2022 at a glance: focus on epidemiology, prognosis and comorbidities

Updates in heart failure: sodium glucose co-transporter 2 inhibitors and beyond – major changes are coming

Contact Info

Product

Resources

About