A greater number of guideline-directed medical therapy was associated with improvement of the prognosis after mitral transcatheter edge-to-edge repair - insight from OCEAN-Mitral Registry-

Abstract Backgrounds Although mitral transcatheter edge-tot-edge repair (M-TEER) is an effective treatment for patients with heart failure (HF) and functional mitral regurgitation (FMR), it is still difficult to improve the prognosis sufficiently. Therefore, adequate guideline directed medical therapy (GDMT) implementation is needed. However, a relatively large number of HF patients with FMR have insufficient medications because they cannot tolerate GDMT due to coexisting conditions such as low systemic blood pressure, hyperkalemia, bradycardia, and renal failure. Purpose We aimed to evaluate the impact of the number of GDMT status after M-TEER on prognosis in patients with HF with reduced ejection fraction. Methods This was a multicenter observational study (OCEAN-Mitral Registry) including 1638 patients with HF and left ventricular (LV) ejection fraction 50% who underwent M-TEER for FMR (male 63%, medial age 77 years). The patients were divided into four groups according to the number of GDMT (ACEi or ARB or ARNI, beta blocker, MRA, SGLT2i) at discharge; 0 or 1 (N=183), 2 (N=505), 3 (N=630), and 4 (N=320). The primary endpoint was composite of all-cause death and HF-rehospitalization. Results Patients taking greater number of medications likely to be younger, had lower STS scores, lower blood pressure, lower heart rate, lower hemoglobin level, and better renal function. Echocardiography showed worse LV function, an enlarged LV, and a lower right ventricular systolic pressure in patients with taking greater number of medications. The primary endpoint occurred in 486 patients (30%) during 465 days of median follow-up period. Kaplan-Meier analysis revealed patients taking greater medications had a better prognosis at one year (log-rank trend: P0.01) (Figure 1). After adjusting for covariates, Cox regression analysis revealed that the number of GDMT was an independent prognosticator of composite of all-cause death and HF-rehospitalization in one year (hazard ratio: 0.85, 95% confidence interval: 0.75-0.97). Furthermore, patients who added medications after M-TEER showed better composite outcomes compared with patients who could not increase medication even taking no or one of medication before M-TEER (Figure 2). Conclusion Patients taking greater number of GDMT had better prognosis. Furthermore, the prognosis also improves in patients who were able to increase the number of GDMT after M-TEER. Sufficient GDMT is still needed in patients with low ejection fraction who underwent M-TEER.Figure 1 Figure 2