156 IMPACT OF TRANSCATHETER EDGE-TO-EDGE MITRAL VALVE REPAIR ON GUIDELINE DIRECTED MEDICAL THERAPY OPTIMIZATION IN PATIENT WITH SECONDARY MITRAL REGURGITATION

Abstract

Abstract Background Guideline-directed medical therapy (GDMT) optimization is mandatory before transcatheter edge-to-edge mitral valve repair (M-TEER) in patients with secondary mitral regurgitation (SMR) and heart failure with reduced ejection fraction (HFrEF). However, the effect of M-TEER on GDMT is unknown. Objective To evaluate frequency and prognostic implications and predictors of GDMT optimization after M-TEER in patients with SMR and HFrEF. Methods This is a retrospective analysis of prospectively collected data from the EuroSMR Registry. The primary events were all-cause death and the composite of all-cause death or HF hospitalization. Results Among the 1641 EuroSMR patients, 810 had full datasets regarding GDMT and were included in this study. GDMT optimization occurred in 307 (38%) patients after M-TEER. Proportion of patients receiving ACEi/ARB/ARNI, betablockers and MRA was 78%, 89% and 62% before M-TEER and 84%, 91% and 66% 6-month after M-TEER (All p<0.001). Patients with GDMT optimization had a lower risk of all-cause death (adjusted hazard ratio [HR] 0.62; 95% confidence interval [CI] 0.41-0.93; p=0.020) and the composite of all-cause death or HF hospitalization (adjusted HR 0.54; 95% CI 0.38-0.76; p<0.001) compared with those without. Degree of MR reduction between baseline and 6-month follow-up was an independent predictor of GDMT optimization after M-TEER (adjusted OR 1.71; 95% CI 1.08-2.71; p=0.022). Conclusions GDMT optimization after M-TEER in HFrEF patients with SMR occurred in a considerable proportion of patients and is independently associated with lower rates for mortality and HF hospitalizations. A greater decrease in MR was associated with increased likelihood for GDMT optimization.