| Autor: |
Balogh, Zsuzsanna Dorka, Collet, Carlos, Van Camp, Guy, Vanderheyden, Marc, Bartunek, Jozef, Beles, Monika, Katbeh, Asim, Albano, Marzia, Stefanidis, Evangelos, Penicka, Martin |
| Zdroj: |
Circulation (Ovid); November 2019, Vol. 140 Issue: Supplement 1 pA12828-A12828, 1p |
| Abstrakt: |
Introduction:In patients with heart failure and preserved ejection fraction (HFPEF), even mild secondary mitral regurgitation (MR) has been associated with poor outcomeHypothesis:To test the hypothesis that, in patients with non-ischemic HFPEF and secondary MR, endoscopic MVRepair will be associated with improved outcome compared with standard-of-care (StanCare) management.Methods:The MVRepair group consisted of 143 consecutive patients (age 72?7 y, 24% males) with HFPEF and secondary MR who underwent endoscopic MVRepair. The StanCare group consisted of 143 consecutive patients (age 78?9 y, 29% males) with HFPEF admitted for first decompensation. To be eligible for the study, all patients had to have normal LVEF (?50%), H2FPEF score ? 5 and secondary MR. Patients with coronary artery disease or primary MR were excluded. One to one propensity score matching was performed. Primary endpoint was all-cause mortality and HFPEF readmission (time to first event).Results:During median follow up of 4.4 years [IQR 2.2-7.9], significantly more patients had primary endpoint (29% vs 58%, Log-rank p<0.001), died (43% vs 22%, Log-rank p<0.01) or had HFPEF readmission (34% vs 10%, Log-rank p<0.001) in the StanCare versus the MVRepair group (Figure). In Cox regression analyses adjusted for age, MVRepair was the only independently associated with primary endpoint (HR 0.16; 95% CI 0.10-0.27; p<0.001), all-cause mortality (HR 0.25; 95% CI 0.12-0.54; p<0.001) or HFPEF readmissions (HR 0.18; 95% CI 0.09-0.36; p<0.001).In the propensity matched cohort, MVRepair compared with StanCare showed 29% (SE 8.9%) absolute risk reduction of primary endpoint (p 0.001).Conclusions:In HFPEF patients with secondary MR, minimally invasive surgical MVRepair seems to be associated with improved outcome compared to standard of care management. |
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