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. 2024 Feb 23;3(5):101345.
doi: 10.1016/j.jscai.2024.101345. eCollection 2024 May.

Changes in Left Ventricular Function and Outcomes After Trancatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation

Stamatios Lerakis  1 , Annapoorna S Kini  1 , Gennaro Giustino  1 , Malcolm Anastasius  1 , Federico M Asch  2 , Neil J Weissman  2 , Paul A Grayburn  3 , Saibal Kar  4   5 , D Scott Lim  6 , Jacob M Mishell  7 , Brian K Whisenant  8 , Michael J Rinaldi  9 , Samir R Kapadia  10 , Vivek Rajagopal  11 , Ian J Sarembock  12 , Andreas Brieke  13 , Gilbert H L Tang  1 , Yanru Li  14 , Maria C Alu  14 , JoAnn Lindenfeld  15 , William T Abraham  16 , Samin K Sharma  1 , Michael J Mack  3 , Gregg W Stone  1
Affiliations

Changes in Left Ventricular Function and Outcomes After Trancatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation

Stamatios Lerakis et al. J Soc Cardiovasc Angiogr Interv. .

Erratum in

  • Correction.
    [No authors listed] [No authors listed] J Soc Cardiovasc Angiogr Interv. 2025 Aug 9;4(10Part A):103930. doi: 10.1016/j.jscai.2025.103930. eCollection 2025 Oct. J Soc Cardiovasc Angiogr Interv. 2025. PMID: 41268087 Free PMC article.

Abstract

Background: Transcatheter edge-to-edge repair (TEER) improved outcomes in patients with heart failure (HF) and severe secondary mitral regurgitation (SMR) compared with guideline-directed medical therapy (GDMT) alone regardless of the severity of baseline left ventricular ejection fraction (LVEF). The study aimed to evaluate the effect of early changes in LVEF after TEER and GDMT alone in patients with HF and severe SMR.

Methods: Within the COAPT trial, we evaluated outcomes according to changes in LVEF from baseline to 30 days. The primary outcome was all-cause death or HF hospitalization (HFH) between 30 days and 2 years.

Results: Among 432 patients with paired echocardiographic data, 182 (42.1%) had increased LVEF (LVEF change 6.0% ± 4.9%) and 250 (57.9%) had a decrease or no change in LVEF (LVEF change -6.6% ± 5.6%) from baseline to 30 days. LVEF at 30 days increased more frequently with GDMT alone compared with TEER plus GDMT (51.4% vs 33.0%; P = .0001). Between 30 days and 2 years, there were no significant differences in death or HFH in the increase LVEF and the decrease LVEF groups (58.8% vs 51.4%; multivariable-adjusted HR, 0.97; 95% CI, 0.87-1.08; P = .59). TEER plus GDMT reduced the 30-day to 2-year rate of death or HFH compared with GDMT alone consistently in patients with increase LVEF and decrease LVEF (Pint = 0.75).

Conclusions: Among patients with HF and severe SMR, early improvements in LVEF were more frequent with GDMT alone compared with TEER plus GDMT but were not associated with subsequent outcomes at 2 years. TEER reduced death or HFH during 2-year follow-up irrespective of early LVEF changes.

Keywords: GDMT; TEER; guideline-directed medical therapy; left ventricular ejection fraction; secondary mitral regurgitation; transcatheter edge-to-edge repair.

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Figures

Figure 1
Figure 1
Kaplan-Meier time-to-first event curves for outcomes between 30 days and 2 years according to changes in left ventricular ejection fraction (LVEF) from baseline to 30 days. (A) All-cause death or heart failure hospitalization (HFH). (B) All-cause death. (C) HFH. dLVEF, decreased (or unchanged) left ventricular ejection fraction; HR, hazards ratio; iLVEF, increased left ventricular ejection fraction.
Figure 2
Figure 2
Cubic spline regression for outcomes between 30 days and 2 years according to changes in left ventricular ejection fraction (LVEF) from baseline to 30 days. (A) All-cause death or heart failure hospitalization (HFH). (B) All-cause death. (C) HFH.
Figure 3
Figure 3
Kaplan-Meier time-to-first event curves for outcomes between 30 days and 2 years according to changes in left ventricular ejection fraction (LVEF) from baseline to 30 days and randomized group. (A) All-cause death or heart failure hospitalization (HFH). (B) All-cause death. (C) HFH. dLVEF, decreased (or unchanged) left ventricular ejection fraction; GDMT, guideline-directed medical therapy; HR, hazards ratio; iLVEF, increased left ventricular ejection fraction; TEER, transcatheter edge-to-edge repair.
Central Illustration
Central Illustration
The benefits of transcatheter-edge-to-edge repair (TEER) in heart failure patients with severe secondary mitral regurgitation are realized independently of early changes in left ventricular ejection fraction (LVEF). dLVEF, decreased (or unchanged) left ventricular ejection fraction; GDMT, guideline-directed medical therapy; HFH, heart failure hospitalization; iLVEF, increased left ventricular ejection fraction.
See this image and copyright information in PMC

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