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Implication of the Dose of Mineralocorticoid Receptor Antagonist Following Transcatheter Edge-to-Edge Mitral Valve

Teruhiko Imamura1, Shuhei Tanaka1, Nobuyuki Fukuda1

  • 1Second Department of Internal Medicine, University of Toyama, Toyama, Japan.

JACC. Asia
|May 28, 2025
PubMed
Abstract

Insights

Mineralocorticoid receptor antagonists (MRAs) improve outcomes for older patients after transcatheter edge-to-edge mitral valve repair (TEER). Low-dose MRAs showed benefits, but higher doses did not offer further advantages.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Medicine

Background:

  • Mineralocorticoid receptor antagonists (MRAs) are crucial for heart failure with reduced ejection fraction.
  • The role of MRA dosing in elderly patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) for secondary mitral regurgitation is not well-defined.

Purpose of the Study:

  • To assess the prognostic impact of mineralocorticoid receptor antagonist (MRA) dosing in elderly patients receiving TEER for secondary mitral regurgitation.

Main Methods:

  • Analysis of the OCEAN-Mitral registry data for patients with left ventricular ejection fraction <50% undergoing TEER.
  • Evaluation of the dose-dependent effects of MRA administered at discharge on the 2-year composite outcome of all-cause mortality and heart failure hospitalization.

Main Results:

  • In 2,026 older patients (median age 77), MRA administration (≥12.5 mg/d) post-TEER was linked to a reduced 2-year incidence of mortality or heart failure hospitalization (adjusted HR 0.83; P=0.046).
  • Higher MRA doses did not demonstrate a significant additional risk reduction for the primary composite outcome (P=0.97).

Conclusions:

  • Even low-dose MRAs are associated with improved clinical outcomes in older patients post-TEER for secondary mitral regurgitation compared to no MRA.
  • Up-titrating MRA doses beyond a certain threshold did not yield further clinical benefits.
Keywords:
MitraClipheart failurehemodynamicsvalvular disease

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