{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T11:04:55Z","timestamp":1785150295750,"version":"3.55.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":1043,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T00:00:00Z","timestamp":1672790400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Abbott, Santa Clara, CA"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Patients with severe mitral regurgitation (MR) and acute heart failure (HF) have refractory symptoms without adequate response to medical therapy. The objective of this analysis was to assess the impact of the MitraClip device in acutely ill HF patients, characterized by NYHA Class IV at baseline, in a real-world, contemporary setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>EXPAND was a prospective, multicenter, international study enrolling patients with MR who consented to receive the MitraClip System at 57 sites globally. The study outcomes included acute procedural success (APS), quality of life, heart failure hospitalizations (HFH), and all-cause mortality. The study population comprised 1,041 patients, with 118 patients having baseline NYHA Class IV, and 922 having baseline NYHA Class I\/II\/III. NYHA Class IV patients had a significantly higher rate of baseline co-morbidities and secondary MR aetiology compared with NYHA Class I\/II\/III patients. APS was achieved in 92.4% of NYHA Class IV patients and significant improvement in MR grade to \u2264Mild (1+) in 90.7% of subjects at 30 days and 92.9% at 1 year was observed. 1-year-mortality was higher in the NYHA Class IV subjects compared with the NYHA Class I\/II\/III subjects (29.2% vs. 17.7%, P &amp;lt; 0.01). Significant improvement in functional capacity assessed by NYHA Functional Class and Quality of Life assessed through KCCQ score was observed. At 1 year, 72.6% of NYHA Class IV subjects improved to NYHA Class I\/II and \u0394KCCQ was 31.2 (24.1, 38.3) compared with baseline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In the prospective, real-world EXPAND study, MitraClip in patients with severe MR and NYHA Class IV was found to be safe and effective in treating MR, and significantly improving QoL and long-term clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.14273","type":"journal-article","created":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T18:31:02Z","timestamp":1672857062000},"page":"1122-1132","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Safety and Efficacy of MitraClip in Acutely Ill (NYHA Class IV) Patients with Mitral Regurgitation: Results from the Global EXPAND Study"],"prefix":"10.1093","volume":"10","author":[{"given":"Mony","family":"Shuvy","sequence":"first","affiliation":[{"name":"Jesselson Integrated Heart Centre, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University , Jerusalem ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph Stephan","family":"von Bardeleben","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center of Mainz , Mainz ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmelo","family":"Grasso","sequence":"additional","affiliation":[{"name":"Division of Cardiology, C.A.S.T., Azienda Ospedaliero Universitaria Policlinico \"G. Rodolico-San Marco\", University of Catania , Catania ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Raake","sequence":"additional","affiliation":[{"name":"Heidelberg University Hospital , Heidelberg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Lurz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Center Leipzig at University Leipzig , Leipzig ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose L.","family":"Zamorano","sequence":"additional","affiliation":[{"name":"Cibercv, Hospital Ramon y Cajal , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Asch","sequence":"additional","affiliation":[{"name":"Cardiovascular Core Laboratories, MedStar Health Research Institute , Washington, District of Columbia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saibal","family":"Kar","sequence":"additional","affiliation":[{"name":"Los Robles Regional Medical Center , Thousand Oaks, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Maisano","sequence":"additional","affiliation":[{"name":"San Raffaele University Hospital , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"EXPAND Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,1,4]]},"reference":[{"key":"2026012114111174500_ehf214273-bib-0001","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/nrcardio.2010.165","article-title":"Epidemiology and risk profile of heart failure","volume":"8","author":"Bui","year":"2011","journal-title":"Nat Rev Cardiol"},{"key":"2026012114111174500_ehf214273-bib-0002","doi-asserted-by":"crossref","first-page":"e139","DOI":"10.1161\/CIR.0000000000000757","article-title":"Heart disease and stroke Statistics-2020 update: a report from the American Heart Association","volume":"141","author":"Virani","year":"2020","journal-title":"Circulation"},{"key":"2026012114111174500_ehf214273-bib-0003","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1136\/hrt.2006.098814","article-title":"Management of end stage heart failure","volume":"93","author":"Friedrich","year":"2007","journal-title":"Heart"},{"key":"2026012114111174500_ehf214273-bib-0004","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.119.014240","article-title":"Clinical implications of the New York heart association classification","volume":"8","author":"Caraballo","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"2026012114111174500_ehf214273-bib-0005","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1093\/eurjhf\/hft134","article-title":"Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? 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