Percutaneous Mitral Valve Repair versus Optimal Medical Therapy in Patients with Functional Mitral Regurgitation: A Systematic Review and Meta-Analysis
Objectives. To compare percutaneous mitral valve repair (PMVR) with optimal medical therapy (OMT) in patients with heart failure (HF) and severe functional mitral regurgitation (FMR). Background. Many patients with HF and FMR are not suitable for surgical valve replacement and remain symptomatic des...
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2019-01-01
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Series: | Journal of Interventional Cardiology |
Online Access: | http://dx.doi.org/10.1155/2019/2753146 |
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doaj-5e2c5d86c7964657b257f239595475762020-11-25T01:36:56ZengHindawi-WileyJournal of Interventional Cardiology0896-43271540-81832019-01-01201910.1155/2019/27531462753146Percutaneous Mitral Valve Repair versus Optimal Medical Therapy in Patients with Functional Mitral Regurgitation: A Systematic Review and Meta-AnalysisMuhammad Uzair Lodhi0Muhammad Shariq Usman1Tariq Jamal Siddiqi2Muhammad Shahzeb Khan3Muhammad Arbaz Arshad Khan4Safi U. Khan5Intekhab Askari Syed6Mustafa Rahim7Srihari S. Naidu8Rami Doukky9Mohamad Alkhouli10Department of Internal Medicine, Raleigh General Hospital, West Virginia University, WV, USADepartment of Internal Medicine, Civil Hospital, Dow University, Karachi, PakistanDepartment of Internal Medicine, Civil Hospital, Dow University, Karachi, PakistanDepartment of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL, USADepartment of Internal Medicine, Civil Hospital, Dow University, Karachi, PakistanDepartment of Internal Medicine, West Virginia University, WV, USADepartment of Internal Medicine, Raleigh General Hospital, West Virginia University, WV, USADepartment of Internal Medicine, West Virginia University, WV, USADivision of Cardiology, Westchester Medical Center, Valhalla, NY, USADepartment of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL, USADivision of Cardiology, West Virginia University, Morgantown, WV, USAObjectives. To compare percutaneous mitral valve repair (PMVR) with optimal medical therapy (OMT) in patients with heart failure (HF) and severe functional mitral regurgitation (FMR). Background. Many patients with HF and FMR are not suitable for surgical valve replacement and remain symptomatic despite maximal OMT. PMVR has recently emerged as an alternative solution. Methods. We performed a systematic review and a meta-analysis to address this question. Cochrane CENTRAL, MEDLINE, and Scopus were searched for randomized (RCT) and nonrandomized studies comparing PMVR with OMT in patients with HF and FMR. Primary endpoint was all-cause midterm mortality (at 1 and 2 years). Secondary endpoints were 30-day mortality and cardiovascular mortality and HF hospitalizations, at maximum follow-up. Studies including mixed cohort of degenerative and functional MR were allowed initially but were excluded in a secondary sensitivity analysis for each of the study’s end points. This meta-analysis was performed following the publication of two RCTs (MITRA-FR and COAPT). Results. Eight studies (six observational, two RCTs) comprising 3,009 patients were included in the meta-analysis. In comparison with OMT, PMVR significantly reduced 1-year mortality (RR: 0.70 [0.56, 0.87]; p=0.002; I2=47.6%), 2-year mortality (RR: 0.63 [0.55, 0.73]; p<0.001; I2=0%), and cardiovascular mortality (RR: 0.32 [0.23, 0.44]; p<0.001; I2=0%). No significant difference between PMVR+OMT and OMT was noted in HF hospitalization (HR: 0.69 [0.40, 1.20]; p=0.19; I2=85%) and 30-day mortality (RR: 1.13 [0.68, 1.87]; p=0.16; I2=0%). Conclusions. In comparison with OMT, PMVR significantly reduces 1-year mortality, 2-year mortality, and cardiovascular mortality in patients with HF and severe MR.http://dx.doi.org/10.1155/2019/2753146 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Muhammad Uzair Lodhi Muhammad Shariq Usman Tariq Jamal Siddiqi Muhammad Shahzeb Khan Muhammad Arbaz Arshad Khan Safi U. Khan Intekhab Askari Syed Mustafa Rahim Srihari S. Naidu Rami Doukky Mohamad Alkhouli |
spellingShingle |
Muhammad Uzair Lodhi Muhammad Shariq Usman Tariq Jamal Siddiqi Muhammad Shahzeb Khan Muhammad Arbaz Arshad Khan Safi U. Khan Intekhab Askari Syed Mustafa Rahim Srihari S. Naidu Rami Doukky Mohamad Alkhouli Percutaneous Mitral Valve Repair versus Optimal Medical Therapy in Patients with Functional Mitral Regurgitation: A Systematic Review and Meta-Analysis Journal of Interventional Cardiology |
author_facet |
Muhammad Uzair Lodhi Muhammad Shariq Usman Tariq Jamal Siddiqi Muhammad Shahzeb Khan Muhammad Arbaz Arshad Khan Safi U. Khan Intekhab Askari Syed Mustafa Rahim Srihari S. Naidu Rami Doukky Mohamad Alkhouli |
author_sort |
Muhammad Uzair Lodhi |
title |
Percutaneous Mitral Valve Repair versus Optimal Medical Therapy in Patients with Functional Mitral Regurgitation: A Systematic Review and Meta-Analysis |
title_short |
Percutaneous Mitral Valve Repair versus Optimal Medical Therapy in Patients with Functional Mitral Regurgitation: A Systematic Review and Meta-Analysis |
title_full |
Percutaneous Mitral Valve Repair versus Optimal Medical Therapy in Patients with Functional Mitral Regurgitation: A Systematic Review and Meta-Analysis |
title_fullStr |
Percutaneous Mitral Valve Repair versus Optimal Medical Therapy in Patients with Functional Mitral Regurgitation: A Systematic Review and Meta-Analysis |
title_full_unstemmed |
Percutaneous Mitral Valve Repair versus Optimal Medical Therapy in Patients with Functional Mitral Regurgitation: A Systematic Review and Meta-Analysis |
title_sort |
percutaneous mitral valve repair versus optimal medical therapy in patients with functional mitral regurgitation: a systematic review and meta-analysis |
publisher |
Hindawi-Wiley |
series |
Journal of Interventional Cardiology |
issn |
0896-4327 1540-8183 |
publishDate |
2019-01-01 |
description |
Objectives. To compare percutaneous mitral valve repair (PMVR) with optimal medical therapy (OMT) in patients with heart failure (HF) and severe functional mitral regurgitation (FMR). Background. Many patients with HF and FMR are not suitable for surgical valve replacement and remain symptomatic despite maximal OMT. PMVR has recently emerged as an alternative solution. Methods. We performed a systematic review and a meta-analysis to address this question. Cochrane CENTRAL, MEDLINE, and Scopus were searched for randomized (RCT) and nonrandomized studies comparing PMVR with OMT in patients with HF and FMR. Primary endpoint was all-cause midterm mortality (at 1 and 2 years). Secondary endpoints were 30-day mortality and cardiovascular mortality and HF hospitalizations, at maximum follow-up. Studies including mixed cohort of degenerative and functional MR were allowed initially but were excluded in a secondary sensitivity analysis for each of the study’s end points. This meta-analysis was performed following the publication of two RCTs (MITRA-FR and COAPT). Results. Eight studies (six observational, two RCTs) comprising 3,009 patients were included in the meta-analysis. In comparison with OMT, PMVR significantly reduced 1-year mortality (RR: 0.70 [0.56, 0.87]; p=0.002; I2=47.6%), 2-year mortality (RR: 0.63 [0.55, 0.73]; p<0.001; I2=0%), and cardiovascular mortality (RR: 0.32 [0.23, 0.44]; p<0.001; I2=0%). No significant difference between PMVR+OMT and OMT was noted in HF hospitalization (HR: 0.69 [0.40, 1.20]; p=0.19; I2=85%) and 30-day mortality (RR: 1.13 [0.68, 1.87]; p=0.16; I2=0%). Conclusions. In comparison with OMT, PMVR significantly reduces 1-year mortality, 2-year mortality, and cardiovascular mortality in patients with HF and severe MR. |
url |
http://dx.doi.org/10.1155/2019/2753146 |
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