Implication of the Dose of Mineralocorticoid Receptor Antagonist Following Transcatheter Edge-To-Edge Mitral Valve Repair.

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).