Key result
TEER plus guideline-directed medical therapy did not significantly improve left ventricular end-diastolic diameter (MD -1.02 mm) or other echocardiographic parameters of reverse remodeling compared to GDMT alone in patients with secondary mitral regurgitation.
Why the study?
There is limited evidence on the effectiveness of transcatheter edge-to-edge repair (TEER) in achieving reverse remodeling in patients with secondary mitral regurgitation (SMR).
Does TEER plus GDMT improve echocardiographic parameters of reverse remodeling compared to GDMT alone in patients with secondary mitral regurgitation and heart failure?
Meta-Analysis
Does TEER plus GDMT improve echocardiographic parameters of reverse remodeling compared to GDMT alone in patients with secondary mitral regurgitation and heart failure?
Mean Difference: -1.02 (95% CI -2.81–0.78)
TEER results in statistically significant but clinically small changes in echocardiographic parameters of reverse remodeling, with no clear advantage over GDMT alone in patients with secondary mitral regurgitation.
Background and aim: Transcatheter edge-to-edge repair (TEER) is a minimally invasive approach to reduce secondary mitral regurgitation (SMR) in patients with heart failure. However, there is limited evidence on its effectiveness in achieving reverse remodeling. Our aim was to assess the effects of TEER over time and to compare the effects of TEER plus GDMT vs. GDMT alone on echocardiographic parameters. Methods: A systematic search of MEDLINE, EMBASE, and CENTRAL was conducted from inception to November 16, 2023. Eligible studies included patients with SMR treated with TEER and echocardiographic follow-ups. We evaluated changes in left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left atrial volume (LAV), left ventricular ejection fraction (LVEF) and NTproBNP levels. Results: Of 9,290 identified studies, 38 met inclusion criteria. After TEER, statistically significant reductions were observed in LVEDD (-1.63 mm), LVESD (-1.20 mm), LVEDV (-14.21 mL), and LVESV (-9.24 mL). Changes in LAV (-5.70 mL) and LVEF (+1.10%) were not statistically or clinically meaningful. NT-proBNP decreased substantially (-1,340 pg/mL). In comparative analyses, TEER plus GDMT did not show statistically significant differences vs. GDMT alone for any parameter, including LVEDD (-1.02 mm), LVEDV (-11.98 mL), LVEF (-0.14%), and LVESV (-5.29 mL). TEER reduced grade 3-4 MR from 99% to 9%. Systematic Review Registration: identifier CRD42023483404. Conclusion: TEER results in statistically significant but clinically small changes in echocardiographic parameters, and no clear advantage over GDMT alone. These findings should be interpreted with caution given the high heterogeneity and low certainty of evidence. Further studies are needed to define which SMR patient subgroups may derive meaningful reverse-remodeling benefit from TEER. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=483404, PROSPERO CRD42023483404.
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Lichtfusz et al. (2026) conducted a meta-analysis in Secondary mitral regurgitation and heart failure. Transcatheter edge-to-edge repair (TEER) plus GDMT vs. Guideline-directed medical therapy (GDMT) alone was evaluated on Difference in change of left ventricular end-diastolic diameter (LVEDD) (MD -1.02 mm, 95% CI -2.81 to 0.78). TEER plus guideline-directed medical therapy did not significantly improve left ventricular end-diastolic diameter (MD -1.02 mm) or other echocardiographic parameters of reverse remodeling compared to GDMT alone in patients with secondary mitral regurgitation.
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