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Meta-Analysis
. 2020 Jul;21(7):857-864.
doi: 10.1016/j.carrev.2019.11.003. Epub 2019 Nov 15.

Left Ventricular Size Predicts Clinical Benefit After Percutaneous Mitral Valve Repair for Secondary Mitral Regurgitation: A Systematic Review and Meta-Regression Analysis

Marco Zimarino  1 , Fabrizio Ricci  2 , Davide Capodanno  3 , Carlo De Innocentiis  4 , Elvira Verrengia  4 , Martin J Swaans  5 , Carlo Lombardi  6 , Jorn Brouwer  5 , Sabina Gallina  4 , Carmelo Grasso  3 , Raffaele De Caterina  7 , Corrado Tamburino  3
Affiliations
Meta-Analysis

Left Ventricular Size Predicts Clinical Benefit After Percutaneous Mitral Valve Repair for Secondary Mitral Regurgitation: A Systematic Review and Meta-Regression Analysis

Marco Zimarino et al. Cardiovasc Revasc Med. 2020 Jul.

Abstract

Background: The benefit of percutaneous mitral valve repair (PMVR) in patients with secondary MR is still debated. We aimed to compare the outcome of PMVR with optimal medical therapy (OMT) versus OMT alone in patients with secondary mitral regurgitation (MR) and to assess the role of potential effect modifiers.

Methods: We performed a systematic review and meta-analysis of 2 randomized clinical trials (RCT) and 7 non-randomized observational studies (nROS). Hazard ratios (HR) and 95% confidence intervals (CI) were pooled through inverse variance random-effects model to compute the summary effect size for all-cause death, cardiovascular death and cardiac-related hospitalization. Subgroup and meta-regression analysis were also performed.

Results: An overall population of 3118 individuals (67% men; mean age, 73 years) was included: 1775 PMVR+OMT and 1343 OMT patients, with mean follow-up of 24 ± 15 months. PMVR+OMT was associated with a lower risk of all-cause death (HR: 0.77; 95% CI: 0.68-0.87), cardiovascular death (HR: 0.55; 95% CI: 0.34-0.89) and cardiac-related hospitalization (HR:0.77; 95% CI: 0.64-0.92). Meta-regression analysis showed that larger left ventricular end-diastolic volume index (LVEDVI) portends higher risk of all-cause death, cardiovascular death and cardiac-related hospitalization after PMVR (p < 0.001 for all).

Conclusions: This study-level meta-analysis shows that PMVR+OMT is associated with reduced all-cause death, cardiovascular death and cardiac-related hospitalization when compared with OMT alone in secondary MR. LVEDVI is a predictive marker of efficacy, as patients with smaller LVEDVI have been shown to derive the largest benefit from PMVR.

Keywords: Heart failure; Meta-analysis; Mitral regurgitation; Percutaneous mitral valve repair.

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Conflict of interest statement

Declaration of competing interest Marco Zimarino: Name of Entity: None. Fabrizio Ricci: Name of Entity: None. Davide Capodanno: Name of Entity: Abbott Vascular, Financial Relationship: Consulting Fee, Amount: Modest. Carlo De Innocentiis: Name of Entity: None. Martin J. Swaans: Name of Entity: Abbott Vascular, Financial Relationship: Consulting Fee, Amount: Modest. Name of Entity: Boston Scientific, Financial Relationship: Speaker Fee, Amount: Modest. Name of Entity: Philips Healthcare, Financial Relationship: Consulting Fee, Amount: Modest. Carlo Lombardi: Name of Entity: None. Jorn Brouwer: Name of Entity: None. Sabina Gallina: Name of Entity: None. Carmelo Grasso: Name of Entity: Abbott Vascular, Financial Relationship: Speaker Fee, Amount: Modest. Raffaele De Caterina: Name of Entity: Bayer, Financial Relationship: Grants, advisory board fees and support from congress participation, Amount: Modest. Name of Entity: Boehringer Ingelheim, Financial Relationship: Grants, advisory board fees and support from congress participation, Amount: Modest. Name of Entity: BMS/Pfizer, Financial Relationship: Grants, advisory board fees and support from congress participation, Amount: Modest. Name of Entity: Daiichi/ Sankyo, Financial Relationship: Grants, advisory board fees and support from congress participation, Amount: Modest. Name of Entity: Astra-Zeneca, Financial Relationship: Grants, advisory board fees and support from congress participation, Amount: Modest. Name of Entity: Roche, Financial Relationship: Grants, advisory board fees and support from congress participation, Amount: Modest. Name of Entity: Portola, Financial Relationship: Grants, advisory board fees and support from congress participation, Amount: Modest. Name of Entity: Novartis, Financial Relationship: Grants, advisory board fees and support from congress participation, Amount: Modest. Corrado Tamburino: Name of Entity: Medtronic, Financial Relationship: Consulting and Speaker Fees, Amount: Modest. Name of Entity: St. Jude, Financial Relationship: Consulting and Speaker Fees, Amount: Modest. Name of Entity: Daiichi/Sankyo, Financial Relationship: Consulting and Speaker Fees, Amount: Modest. Name of Entity: Stentys, Financial Relationship: Consulting and Speaker Fees, Amount: Modest.

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