Baseline health status is frequently used to assess prognosis and guide treatment decisions in patients with heart failure (HF) and secondary mitral regurgitation. Whether baseline patient-reported health status modifies the benefits of transcatheter mitral repair remains uncertain. In European Heart Journal, a prespecified analysis from the RESHAPE-HF2 trial evaluated whether baseline health status influenced clinical outcomes and subsequent health status changes after mitral transcatheter edge-to-edge repair (M-TEER).

The randomized RESHAPE-HF2 trial enrolled 505 patients with symptomatic HF and moderate-to-severe ventricular secondary mitral regurgitation (vSMR). Baseline health status was assessed using the Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS). Cox proportional hazards models examined whether baseline KCCQ-CSS modified the effect of M-TEER on cardiovascular death or HF hospitalization. Health status changes were assessed using serial KCCQ measurements and responder analyses.

Across KCCQ-CSS tertiles (<38.9, 38.9-66.1, and >66.1), M-TEER showed a consistent trend toward lower risk of cardiovascular death or HF hospitalization, with no significant interaction by baseline health status (P-trend=0.53). M-TEER also improved KCCQ-CSS, symptom, and overall summary scores at 1, 6, 12, and 24 months. At 6 months, clinically meaningful improvements of at least 5, 10, or 15 points occurred more frequently, while deterioration was less common.

These findings indicate that M-TEER benefits were consistent across baseline health status levels and were associated with sustained improvements in patient-reported outcomes.