MRA administration (≥12.5 mg/day) at discharge in elderly TEER patients was associated with a lower 2-year risk of mortality or heart failure hospitalization (HR 0.83; 95% CI 0.69-0.99; p=0.046).
Cohort (n=2,026)
Yes
Does mineralocorticoid receptor antagonist administration improve outcomes in elderly patients undergoing TEER for secondary mitral regurgitation with systolic heart failure?
In elderly patients undergoing TEER for secondary mitral regurgitation with systolic heart failure, low-dose MRA at discharge is associated with improved 2-year clinical outcomes, with no additional benefit observed from dose up-titration.
Hazard Ratio: 0.83 (95% CI 0.69–0.99)
p-value: p=0.046
Abstract Background Mineralocorticoid receptor antagonists (MRAs) are integral components of medical therapy for patients with heart failure with reduced ejection fraction. However, implication of MRA dosing in elderly patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) for secondary mitral regurgitation remains uncertain. Objectives We aimed to investigate the prognostic impacts of MRA dosing in elderly patients receiving TEER for secondary mitral regurgitation. Methods This study included patients who underwent TEER and were enrolled in the multicenter OCEAN-Mitral registry. Patients with a left ventricular ejection fraction of less than 50% and secondary mitral regurgitation were selected. The dose-dependent effects of MRA, administered at discharge, on the 2-year composite outcome of all-cause mortality and heart failure hospitalization were evaluated. Results A total of 2,026 patients (median age 77 years, 1,287 men) were included. Post-TEER, the administration of MRA at a dose of ≥12.5 mg/day (i.e., any doses of MRA) was independently associated with a lower 2-year cumulative incidence of the primary composite outcome, with an adjusted hazard ratio of 0.83 (95% confidence interval, 0.69-0.99; p = 0.046). In contrast, higher doses of MRA were not significantly associated with a further reduction in the risk of the primary outcome (p = 0.97; Figure). Conclusions In elderly patients who underwent TEER for secondary mitral regurgitation due to systolic heart failure, even a low-dose MRA was associated with improved clinical outcomes compared to no MRA administration. However, further up-titration of the MRA dose did not necessarily result in additional improvements in clinical outcomes.Fig 1:MRA dosing and clinical outcome
Imamura et al. (Sat,) conducted a cohort in Secondary mitral regurgitation and systolic heart failure (n=2,026). Mineralocorticoid receptor antagonists (MRAs) vs. No MRA administration was evaluated on 2-year composite outcome of all-cause mortality and heart failure hospitalization (HR 0.83, 95% CI 0.69-0.99, p=0.046). MRA administration (≥12.5 mg/day) at discharge in elderly TEER patients was associated with a lower 2-year risk of mortality or heart failure hospitalization (HR 0.83; 95% CI 0.69-0.99; p=0.046).