Implication of the Dose of Mineralocorticoid Receptor Antagonist Following Transcatheter Edge-to-Edge Mitral Valve Repair
Year: 2025
Type: article
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 older patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) for secondary mitral regurgitation remains uncertain. OBJECTIVES: The authors aimed to investigate the prognostic impacts of MRA dosing in older patients receiving TEER for secondary mitral regurgitation. METHODS: This study included patients who underwent TEER and were enrolled in the OCEAN (Optimized CathEter vAlvular iNtervention)-Mitral registry. Patients with a left ventricular ejection fraction <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 and followed for a median 416 days (Q1-Q3: 294-730 days). Post-TEER, the administration of MRA at a dose of ≥12.5 mg/d (ie, any doses of MRA) was independently associated with a lower 2-year cumulative incidence of the primary composite outcome, with an adjusted HR of 0.83 (95% CI: 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). CONCLUSIONS: In older patients who underwent TEER for secondary mitral regurgitation caused by systolic heart failure, even a low-dose MRA was associated with improved clinical outcomes compared with no MRA administration. However, further up-titration of the MRA dose did not result in additional improvements in clinical outcomes. (OCEAN-Mitral registry; UMIN000023653).
Source: JACC Asia
Authors: Teruhiko Imamura, Shuhei Tanaka, Nobuyuki Fukuda, Hiroshi Ueno, Koichiro Kinugawa, Shunsuke Kubo, Masanori Yamamoto, Yuki Izumi, Mike Saji, Masahiko Asami, Yusuke Enta, Shinichi Shirai, Masaki Izumo, Shingo Mizuno, Yusuke Watanabe, Makoto Amaki, Kazuhisa Kodama, Junichi Yamaguchi, Toru Naganuma, Hiroki Bota, Yohei Ohno, Daisuke Hachinohe, Masahiro Yamawaki, Kazuki Mizutani, Toshiaki Otsuka, Kentaro Hayashida
Institutions: University of Toyama, Kurashiki Central Hospital, Toyohashi Heart Center, Nagoya Heart Center, Gifu Heart Center, Toho University, Mitsui Memorial Hospital, Sendai Kousei Hospital, Kokura Memorial Hospital, St. Marianna University Hospital, Shonan Kamakura General Hospital, Teikyo University, National Cerebral and Cardiovascular Center, Saiseikai Kumamoto Hospital, Tokyo Women's Medical University, New Tokyo Hospital, Sapporo Higashi Tokushukai Hospital, Tokai University, Tokai University Hospital, Saiseikai Yokohama Eastern Hospital, Kindai University, Nippon Medical School, Keio University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,084
OpenAlex ID: W4410766832