أعرض في EDS

Prognostic impact of MitraClip in patients with left ventricular dysfunction and functional mitral valve regurgitation: A comprehensive meta-analysis of RCTs and adjusted observational studies

التفاصيل البيبلوغرافية
العنوان: Prognostic impact of MitraClip in patients with left ventricular dysfunction and functional mitral valve regurgitation: A comprehensive meta-analysis of RCTs and adjusted observational studies
المؤلفون: Carla Giustetto, Walter Grosso Marra, Maurizio D'Amico, Gabriele Crimi, Mauro Rinaldi, Fabrizio D'Ascenzo, Claudio Moretti, Federico Conrotto, Simone Frea, Leor Perl, Gianluca Alunni, Antonio Montefusco, Maurizio Bertaina, Gaetano M. De Ferrari, Alessandro Galluzzo
المصدر: International Journal of Cardiology. 290:70-76
بيانات النشر: Elsevier BV, 2019.
سنة النشر: 2019
مصطلحات موضوعية: medicine.medical_specialty, 030204 cardiovascular system & hematology, Patient Readmission, law.invention, Ventricular Dysfunction, Left, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, Humans, MitraClip, 030212 general & internal medicine, Randomized Controlled Trials as Topic, business.industry, FMR, Mitral Valve Insufficiency, OMT, HFrEF, Odds ratio, Prognosis, Surgical Instruments, medicine.disease, Observational Studies as Topic, Heart failure, Meta-analysis, Cardiology, Observational study, Cardiology and Cardiovascular Medicine, Mitral valve regurgitation, business, Percutaneous Mitral Valve Repair
الوصف: The real prognostic impact of MitraClip in patients with significant functional mitral regurgitation (FMR) and left ventricular (LV) dysfunction remains to be elucidated. Two randomized controlled trials (RCTs) with conflicting results have been recently published. We conducted a comprehensive meta-analysis of all RCTs and adjusted observational studies to evaluate the clinical impact of percutaneous mitral valve repair when compared with optimal medical therapy (OMT) alone, in patients with symptomatic FMR and LV dysfunction. Death from any cause and heart failure rehospitalizations at the longest available follow-up were the primary endpoints. Cardiac death, one year and short-term death were the secondary ones. 2255 patients (1207 for MitraClip and 1048 for OMT-only) from 8 studies (2 RCTs and 6 observational studies) were included. At a median (mid-term) follow-up of 438 days (IQR 360-625) MitraClip was associated with a significant reduction of all-cause death (odds Ratio [OR] 0.55, 95%CI 0.41-0.73, p 0.001; [ORadj] 0.66, 95%CI 0.49-0.90, p = 0.009) and rehospitalization (OR 0.49, 95%CI 0.24-1.00, p = 0.05 and ORadj 0.63, 95%CI 0.43-0.94, p = 0.02). At one year, adjusted analysis demonstrated a trend favoring the experimental cohort (ORadj 0.73, 95%CI 0.53-1.02, p = 0.07). Meta-regression suggested that benefit of MitraClip on mid-term survival persists even after accounting for the prevalence of implanted CRT, burden of comorbidities, NYHA class, cardiomyopathy etiology and LV function and dimensions. In conclusion, MitraClip for FMR in patients with LV dysfunction is associated with a considerable reduction of death and HF hospitalization at mid-term follow-up. Further ongoing RCTs are needed to strengthen present results.
تدمد: 0167-5273
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::12217c73c493abf2ebf9023989d43cc2
https://doi.org/10.1016/j.ijcard.2019.05.015
حقوق: OPEN
رقم الأكسشن: edsair.doi.dedup.....12217c73c493abf2ebf9023989d43cc2
قاعدة البيانات: OpenAIRE
الوصف
تدمد:01675273