Reframing Valvular Heart Disease in Heart Failure: Lessons from Recent Evidence

Mitral regurgitation and tricuspid regurgitation are two of the most common valvular conditions in individuals living with heart failure. Both are associated with a higher risk of mortality, more frequent hospitalizations, and diminished quality of life.

Despite these outcomes, the clinical community continues to face uncertainty regarding how best to apply transcatheter therapies to these patients. A recent review published in Circulation by Metra and colleagues provides a comprehensive analysis of current evidence, trial limitations, and directions for future research.

Several important themes emerge from this work:

• Mitral regurgitation is not a single disease. It includes subtypes based on its cause—either from changes in the left ventricle (ventricular secondary mitral regurgitation) or from structural changes in the left atrium (atrial secondary mitral regurgitation). Each may respond differently to interventions.

• Patient selection and optimization of heart failure therapy play a major role in outcomes. Some trials, such as the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation study, showed benefit from transcatheter mitral repair. Others, including the Multicentre Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients with Severe Secondary Mitral Regurgitation, did not. These differences may reflect the degree of heart failure treatment provided before and during the trial.

• Tricuspid regurgitation remains even less studied. Recent randomized trials suggest that transcatheter repair may improve symptoms and quality of life, but mortality and hospitalization outcomes remain uncertain.

• Future studies must improve upon several key areas. These include careful phenotyping of patients, standardizing the use of medical therapy, incorporating patient-reported outcomes and biomarkers, and extending follow-up durations to capture longer-term treatment effects.

The field of transcatheter interventions in heart failure is advancing, but critical gaps remain. Continued collaboration among clinicians, trialists, and regulatory bodies will be essential to design studies that yield reliable and actionable data. This is especially important as the population of patients with advanced heart failure and valvular heart disease continues to grow.

You can read the full article here: https://doi.org/10.1161/CIRCULATIONAHA.124.070411