TY - JOUR
T1 - Impact of beta-blocker uptitration on patients after transcatheter edge-to-edge mitral valve repair for secondary mitral regurgitation
T2 - The OCEAN-mitral registry
AU - Saito, Tetsuya
AU - Tsuruta, Hikaru
AU - Iwata, Juri
AU - Kajino, Akiyoshi
AU - Sakata, Shingo
AU - Ryuzaki, Toshinobu
AU - Saji, Mike
AU - Asami, Masahiko
AU - Enta, Yusuke
AU - Shirai, Shinichi
AU - Izumo, Masaki
AU - Mizuno, Shingo
AU - Watanabe, Yusuke
AU - Kubo, Shunsuke
AU - Amaki, Makoto
AU - Kodama, Kazuhisa
AU - Yamaguchi, Junichi
AU - Naganuma, Toru
AU - Bota, Hiroki
AU - Ohno, Yohei
AU - Yamawaki, Masahiro
AU - Ueno, Hiroshi
AU - Mizutani, Kazuki
AU - Nakashima, Masaki
AU - Otsuka, Toshiaki
AU - Yamamoto, Masanori
AU - Ieda, Masaki
AU - Hayashida, Kentaro
N1 - Publisher Copyright:
© 2024 Elsevier B.V.
PY - 2025/1/1
Y1 - 2025/1/1
N2 - Background: Optimal medical therapy for patients with secondary mitral regurgitation (SMR) undergoing transcatheter edge-to-edge mitral valve repair (M-TEER) remains unclear. This study aimed to investigate the association between beta-blocker uptitration and clinical outcomes after M-TEER. Methods: Using data from the Japanese multicenter registry, we examined 1474 patients who underwent M-TEER for SMR between April 2018 and June 2021. Beta-blocker uptitration was defined as an increased dose of beta-blockers 1 month after M-TEER compared with that before M-TEER. The 2-year clinical outcomes were compared between patients with and without beta-blocker uptitration, utilizing multivariable Cox regression analyses and propensity score matching (PSM). Results: Of the 1474 patients who underwent M-TEER, 272 (18.4 %) were receiving increasing doses of beta-blockers at the 1-month follow-up. These patients had lower left ventricular ejection fraction (LVEF) and higher B-type natriuretic peptide levels. Most patients in the beta-blocker uptitration group received less than the target dose of beta-blockers. Multivariable Cox regression analyses showed that beta-blocker uptitration was significantly associated with a lower risk of all-cause (adjusted hazard ratio [HR]: 0.55; 95 % confidence interval [CI]: 0.36–0.84; P = 0.006) and cardiovascular mortalities (adjusted HR: 0.45, 95 % CI: 0.26–0.79, P = 0.006). PSM analyses revealed consistent findings. Subgroup analyses revealed a significant interaction between beta-blocker uptitration and LVEF≤40 % (interaction P = 0.018). Conclusions: In patients with SMR, beta-blocker uptitration after M-TEER was associated with better clinical outcomes, especially in the group with an LVEF≤40 %. Efforts to uptitrate guideline-directed medical therapy after M-TEER for SMR may be necessary, even if reaching the target dose proves challenging.
AB - Background: Optimal medical therapy for patients with secondary mitral regurgitation (SMR) undergoing transcatheter edge-to-edge mitral valve repair (M-TEER) remains unclear. This study aimed to investigate the association between beta-blocker uptitration and clinical outcomes after M-TEER. Methods: Using data from the Japanese multicenter registry, we examined 1474 patients who underwent M-TEER for SMR between April 2018 and June 2021. Beta-blocker uptitration was defined as an increased dose of beta-blockers 1 month after M-TEER compared with that before M-TEER. The 2-year clinical outcomes were compared between patients with and without beta-blocker uptitration, utilizing multivariable Cox regression analyses and propensity score matching (PSM). Results: Of the 1474 patients who underwent M-TEER, 272 (18.4 %) were receiving increasing doses of beta-blockers at the 1-month follow-up. These patients had lower left ventricular ejection fraction (LVEF) and higher B-type natriuretic peptide levels. Most patients in the beta-blocker uptitration group received less than the target dose of beta-blockers. Multivariable Cox regression analyses showed that beta-blocker uptitration was significantly associated with a lower risk of all-cause (adjusted hazard ratio [HR]: 0.55; 95 % confidence interval [CI]: 0.36–0.84; P = 0.006) and cardiovascular mortalities (adjusted HR: 0.45, 95 % CI: 0.26–0.79, P = 0.006). PSM analyses revealed consistent findings. Subgroup analyses revealed a significant interaction between beta-blocker uptitration and LVEF≤40 % (interaction P = 0.018). Conclusions: In patients with SMR, beta-blocker uptitration after M-TEER was associated with better clinical outcomes, especially in the group with an LVEF≤40 %. Efforts to uptitrate guideline-directed medical therapy after M-TEER for SMR may be necessary, even if reaching the target dose proves challenging.
KW - Beta blockers
KW - Guideline-directed medical therapy
KW - Hospitalization for heart failure
KW - Propensity score matching
KW - Transcatheter edge-to-edge mitral valve repair
UR - http://www.scopus.com/inward/record.url?scp=85205305569&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2024.132595
DO - 10.1016/j.ijcard.2024.132595
M3 - 学術論文
C2 - 39326702
AN - SCOPUS:85205305569
SN - 0167-5273
VL - 418
JO - International Journal of Cardiology
JF - International Journal of Cardiology
M1 - 132595
ER -