Pulmonary Hypertension in Transcatheter Mitral Valve Repair for Secondary Mitral Regurgitation: The COAPT Trial.
Pulmonary Hypertension in Transcatheter Mitral Valve Repair for Secondary Mitral Regurgitation: The COAPT Trial.
- 2020
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
BACKGROUND: Pulmonary hypertension worsens prognosis in patients with heart failure (HF) and secondary mitral regurgitation (SMR). CONCLUSIONS: Elevated PASP is associated with a worse prognosis in patients with HF with severe SMR. TMVr with the MitraClip reduced 30-day PASP and 2-year rates of death or HFH compared with GDMT alone, irrespective of PASP. Copyright (c) 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. METHODS: In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial, 614 patients with HF with moderate-to-severe or severe SMR were randomized to TMVr with the MitraClip plus guideline-directed medical therapy (GDMT) (n = 302) versus GDMT alone (n = 312). Baseline pulmonary artery systolic pressure (PASP) estimated from echocardiography was categorized as substantially increased (>=50 mm Hg) versus not substantially increased (<50 mm Hg). OBJECTIVES: This study sought to determine whether baseline pulmonary hypertension influences outcomes of transcatheter mitral valve repair (TMVr) in patients with HF with SMR. RESULTS: Among 528 patients, 184 (82 TMVr, 102 GDMT) had PASP of >=50 mm Hg (mean: 59.1 +/- 8.8 mm Hg) and 344 (171 TMVr, 173 GDMT) had PASP of <50 mm Hg (mean: 36.3 +/- 8.1 mm Hg). Patients with PASP of >=50 mm Hg had higher 2-year rates of death or HF hospitalization (HFH) compared to those with PASP of <50 mm Hg (68.8% vs. 49.1%; adjusted hazard ratio: 1.52; 95% confidence interval: 1.17 to 1.97; p = 0.002). Rates of death or HFH were reduced by TMVr versus GDMT alone, irrespective of baseline PASP (pinteraction = 0.45). TMVr reduced PASP from baseline to 30 days to a greater than GDMT alone (adjusted least squares mean: -4.0 vs. -0.9 mm Hg; p = 0.006), a change that was associated with reduced risk of death or HFH between 30 days and 2 years (adjusted hazard ratio: 0.91 per -5 mm Hg PASP; 95% confidence interval: 0.86 to 0.96; p = 0.0009).
English
0735-1097
10.1016/j.jacc.2020.09.609 [doi] S0735-1097(20)37422-2 [pii]
*Cardiac Catheterization/mt [Methods]
*Heart Failure
*Heart Valve Prosthesis Implantation
*Hypertension, Pulmonary
*Mitral Valve
*Mitral Valve Insufficiency
*Postoperative Complications
Echocardiography/mt [Methods]
Female
Heart Failure/et [Etiology]
Heart Failure/pp [Physiopathology]
Heart Valve Prosthesis Implantation/ae [Adverse Effects]
Heart Valve Prosthesis Implantation/mt [Methods]
Humans
Hypertension, Pulmonary/et [Etiology]
Hypertension, Pulmonary/pp [Physiopathology]
Male
Middle Aged
Mitral Valve Insufficiency/co [Complications]
Mitral Valve Insufficiency/di [Diagnosis]
Mitral Valve Insufficiency/pp [Physiopathology]
Mitral Valve Insufficiency/su [Surgery]
Mitral Valve/dg [Diagnostic Imaging]
Mitral Valve/pa [Pathology]
Mitral Valve/su [Surgery]
Postoperative Complications/di [Diagnosis]
Postoperative Complications/mo [Mortality]
Prognosis
Risk Assessment/mt [Methods]
Risk Assessment/sn [Statistics & Numerical Data]
Risk Factors
Severity of Illness Index
Treatment Outcome
MedStar Heart & Vascular Institute
Journal Article
Research Support, Non-U.S. Gov't
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
BACKGROUND: Pulmonary hypertension worsens prognosis in patients with heart failure (HF) and secondary mitral regurgitation (SMR). CONCLUSIONS: Elevated PASP is associated with a worse prognosis in patients with HF with severe SMR. TMVr with the MitraClip reduced 30-day PASP and 2-year rates of death or HFH compared with GDMT alone, irrespective of PASP. Copyright (c) 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. METHODS: In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial, 614 patients with HF with moderate-to-severe or severe SMR were randomized to TMVr with the MitraClip plus guideline-directed medical therapy (GDMT) (n = 302) versus GDMT alone (n = 312). Baseline pulmonary artery systolic pressure (PASP) estimated from echocardiography was categorized as substantially increased (>=50 mm Hg) versus not substantially increased (<50 mm Hg). OBJECTIVES: This study sought to determine whether baseline pulmonary hypertension influences outcomes of transcatheter mitral valve repair (TMVr) in patients with HF with SMR. RESULTS: Among 528 patients, 184 (82 TMVr, 102 GDMT) had PASP of >=50 mm Hg (mean: 59.1 +/- 8.8 mm Hg) and 344 (171 TMVr, 173 GDMT) had PASP of <50 mm Hg (mean: 36.3 +/- 8.1 mm Hg). Patients with PASP of >=50 mm Hg had higher 2-year rates of death or HF hospitalization (HFH) compared to those with PASP of <50 mm Hg (68.8% vs. 49.1%; adjusted hazard ratio: 1.52; 95% confidence interval: 1.17 to 1.97; p = 0.002). Rates of death or HFH were reduced by TMVr versus GDMT alone, irrespective of baseline PASP (pinteraction = 0.45). TMVr reduced PASP from baseline to 30 days to a greater than GDMT alone (adjusted least squares mean: -4.0 vs. -0.9 mm Hg; p = 0.006), a change that was associated with reduced risk of death or HFH between 30 days and 2 years (adjusted hazard ratio: 0.91 per -5 mm Hg PASP; 95% confidence interval: 0.86 to 0.96; p = 0.0009).
English
0735-1097
10.1016/j.jacc.2020.09.609 [doi] S0735-1097(20)37422-2 [pii]
*Cardiac Catheterization/mt [Methods]
*Heart Failure
*Heart Valve Prosthesis Implantation
*Hypertension, Pulmonary
*Mitral Valve
*Mitral Valve Insufficiency
*Postoperative Complications
Echocardiography/mt [Methods]
Female
Heart Failure/et [Etiology]
Heart Failure/pp [Physiopathology]
Heart Valve Prosthesis Implantation/ae [Adverse Effects]
Heart Valve Prosthesis Implantation/mt [Methods]
Humans
Hypertension, Pulmonary/et [Etiology]
Hypertension, Pulmonary/pp [Physiopathology]
Male
Middle Aged
Mitral Valve Insufficiency/co [Complications]
Mitral Valve Insufficiency/di [Diagnosis]
Mitral Valve Insufficiency/pp [Physiopathology]
Mitral Valve Insufficiency/su [Surgery]
Mitral Valve/dg [Diagnostic Imaging]
Mitral Valve/pa [Pathology]
Mitral Valve/su [Surgery]
Postoperative Complications/di [Diagnosis]
Postoperative Complications/mo [Mortality]
Prognosis
Risk Assessment/mt [Methods]
Risk Assessment/sn [Statistics & Numerical Data]
Risk Factors
Severity of Illness Index
Treatment Outcome
MedStar Heart & Vascular Institute
Journal Article
Research Support, Non-U.S. Gov't