Impact of beta-blocker up titration on patients after transcatheter edge-to-edge mitral valve repair for secondary mitral regurgitation: The OCEAN-mitral registry

Impact of beta-blocker up titration on patients after transcatheter edge-to-edge mitral valve repair for secondary mitral regurgitation: The OCEAN-mitral registry https://doi.org/10.1016/j.ijcard.2024.132595 Abstract Background Optimal medical therapy for patients with secondary mitral regurgitation (SMR) undergoing transcatheter edge-to-edge mitral valve repair (M-TEER) remains unclear. This study aimed to investigate the association between beta-blocker up titration and clinical outcomes after mitral  transcatheter edge-to-edge repair. Methods Using data from the Japanese multicenter registry, we examined 1474 patients who underwent mitral  transcatheter edge-to-edge repair for secondary mitral regurgitation between April 2018 and June 2021. Beta-blocker up titration was defined as an increased dose of beta-blockers 1 month after mitral  transcatheter edge-to-edge repair compared with that before mitral  transcatheter edge-to-edge repair. The 2-year clinical outcomes were compared between patients with and without beta-blocker up titration, utilizing multivariable Cox regression analyses and propensity score matching (PSM). Results Of the 1474 patients who underwent mitral  transcatheter edge-to-edge repair, 272 (18.4 %) were receiving increasing doses of beta-blockers at the 1-month follow-up. These patients had lower left ventricular ejection fraction (LVEF) and higher B-type natriuretic peptide levels. Most patients in the beta-blocker up titration group received less than the target dose of beta-blockers. Multivariable Cox regression analyses showed that beta-blocker up titration was significantly associated with a lower risk of all-cause (adjusted hazard ratio [HR]: 0.55; 95 % confidence interval [CI]: 0.36–0.84; P = 0.006) and cardiovascular mortalities (adjusted HR: 0.45, 95 % CI: 0.26–0.79, P = 0.006). Propensity score matching analyses revealed consistent findings. Subgroup analyses revealed a significant interaction between beta-blocker uptitration and left ventricular ejection fraction ≤40 % (interaction P = 0.018). Conclusions In patients with secondary mitral regurgitation, beta-blocker uptitration after mitral  transcatheter edge-to-edge repair was associated with better clinical outcomes, especially in the group with an left ventricular ejection fraction ≤40 %. Efforts to up titrate guideline-directed medical therapy after mitral  transcatheter edge-to-edge repair for secondary mitral regurgitation may be necessary, even if reaching the target dose proves challenging. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.