ESC Heart Failure
Witte K et al. – 2021 EJHF
Although any degree of Secondary mitral regurgitation (SMR) is known to further complication heart failure symptoms and mortality, a treatment paradigm for patients with mild and moderate SMR is lacking.
The purpose of this investigation was to determine the effects of percutaneous mitral annuloplasty on symptoms, walk distance and left ventricular (LV) structure and function in patients with mild or moderate secondary mitral regurgitation (SMR) in heart failure with reduced ejection fraction. A total of 68 patients from all Carillon trials with mild and moderate SMR were analyzed in a retrospective study of 1 year outcomes.
- New York Heart Association class status was maintained (48%) or improved (46%) in most patients
- Mean KCCQ scores increased from baseline by 10 units [95% confidence interval (CI) 3 to17; P < 0.01]
- Mean 6-min walk test distance increased by 34 m (95% CI 12 to 57; P < 0.01).
- SMR grade improved in 25% of patients and was maintained in 58% of patients with changes in mean regurgitant volume of −7 mL (95% CI −11 to −3; P < 0.001), vena contracta −0.11 cm (95% CI −0.20 to −0.02; P < 0.05), and effective regurgitant orifice area −0.03 cm2 (95% CI −0.06 to −0.01; P < 0.05).
- Survival over 1 year was 89% and freedom from HF hospitalization was 73%
The authors conclude: “Among patients with symptomatic HF and mild or moderate SMR on guideline-directed medical therapy, percutaneous mitral annuloplasty was associated with improvements in symptoms, SMR, a stabilization of LV structure and function, and high survival rates.”