Relationship between Residual Mitral Regurgitation and Clinical and Quality-of-Life Outcomes after Transcatheter and Medical Treatments in Heart Failure: COAPT Trial

Saibal Kar, Michael J. Mack, Jo Ann Lindenfeld, William T. Abraham, Federico M. Asch, Neil J. Weissman, Maurice Enriquez-Sarano, D. Scott Lim, Jacob M. Mishell, Brian K. Whisenant, Jason H. Rogers, Suzanne V. Arnold, David J. Cohen, Paul A. Grayburn, Gregg W. Stone

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background: In the randomized COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation), among 614 patients with heart failure with 3+ or 4+ secondary mitral regurgitation (MR), transcatheter mitral valve repair (TMVr) with the MitraClip reduced MR, heart failure hospitalizations, and mortality and improved quality of life compared with guideline-directed medical therapy (GDMT) alone. We aimed to examine the prognostic relationship between MR reduction and outcomes after TMVr and GDMT alone. Methods: Outcomes in COAPT between 30 days and 2 years were examined on the basis of the severity of residual MR at 30 days. Results: TMVr-treated patients had less severe residual MR at 30 days than GDMT-treated patients (0/1+, 2+, and 3+/4+: 72.9%, 19.9%, and 7.2% versus 8.2%, 26.1%, and 65.8%, respectively [P0.0001]). The rate of composite death or heart failure hospitalizations between 30 days and 2 years was lower in patients with 30-day residual MR of 0/1+ and 2+ compared with patients with 30-day residual MR of 3+/4+ (37.7% versus 49.5% versus 72.2%, respectively [P0.0001]). This relationship was consistent in the TMVr and GDMT arms (Pinteraction=0.92). The improvement in Kansas City Cardiomyopathy Questionnaire score from baseline to 30 days was maintained between 30 days and 2 years in patients with 30-day MR 2+ but deteriorated in those with 30-day MR 3+/4+ (-0.31.7 versus-9.4 4.6 [P=0.0008]) consistently in both groups (Pinteraction=0.95). Conclusions: In the COAPT trial, reduced MR at 30 days was associated with greater freedom from death or heart failure hospitalizations and improved quality of life through 2-year follow-up whether the MR reduction was achieved by TMVr or GDMT.

Original languageEnglish (US)
Pages (from-to)426-437
Number of pages12
JournalCirculation
DOIs
StateAccepted/In press - 2021

Keywords

  • heart failure
  • mitral valve insufficiency
  • prognosis
  • quality of life

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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