Afterload mismatch after transcatheter edge-to-edge repair in functional mitral regurgitation: A propensity-score matched analysis. in European journal of clinical investigation / Eur J Clin Invest. 2025 Mar 27:e70040. doi: 10.1111/eci.70040.

2025
AOU Città della Salute di Torino
ASL Torino 4

Tipo pubblicazione

Journal Article

Autori/Collaboratori (23)Vedi tutti...

Angelini F
Division of Cardiology, Cardiovascular and Thoracic Department, 'Città Della Salute e Della Scienza' Hospital, Torino, Italy.
Pidello S
Division of Cardiology, Cardiovascular and Thoracic Department, 'Città Della Salute e Della Scienza' Hospital, Torino, Italy.
Frea S
Division of Cardiology, Cardiovascular and Thoracic Department, 'Città Della Salute e Della Scienza' Hospital, Torino, Italy.

et alii...

Abstract

BACKGROUND: Transcatheter edge-to-edge repair (TEER) for severe functional mitral regurgitation (FMR) in patients with reduced left ventricular ejection fraction (LVEF) may lead to an acute increase in left ventricular afterload, termed afterload mismatch (AM). This study aimed to redefine AM clinically, analyse its determinants, and assess its prognostic impact post-TEER in FMR patients. METHODS: A multicenter case-control study was conducted, involving FMR patients with LVEF ?35% undergoing TEER. AM post-TEER was defined as the acute (within 24?h) need for escalation of inotropic or mechanical circulatory support. Sixty-eight AM cases were compared with 68 propensity-matched patients. Primary endpoints included in-hospital mortality post-TEER and 2-year all-cause mortality. RESULTS: Median age was 68?years, 76% male. Procedural success was achieved in 92% of patients. Proportionate MR was associated with a higher risk of AM (adj-HR 1.6, 95% CI 1.01-2.6, p?=?.04). Conversely, pretreatment with levosimendan (adj-HR .29, 95% CI .12-.70, p?