ArticleJACC. Asia2025
Implication of the Dose of Mineralocorticoid Receptor Antagonist Following Transcatheter Edge-to-Edge Mitral Valve Repair.
Article in JACC. Asia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Interplay between medical and interventional therapies in valvular heart disease and heart failure: an expert opinion paper.ESC heart failure · 2026Review
- Medical Therapy Following Transcatheter Edge-to-Edge Repair for Functional Mitral Regurgitation: Where Is the Path Forward?JACC. Asia · 2025Article
- Medical Therapy for Heart Failure After Mitral Valve Transcatheter Repair: One Size Does Not Fit All.JACC. Asia · 2025Article
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Authors and funding
28 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundMineralocorticoid 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.
objectivesThe authors aimed to investigate the prognostic impacts of MRA dosing in older patients receiving TEER for secondary mitral regurgitation.
methodsThis 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.
resultsA 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).
conclusionsIn 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).
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