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Echocardiographic Outcomes After Transcatheter Leaflet Approximation in Patients With Secondary Mitral Regurgitation: The COAPT Trial.

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Citation: Journal of the American College of Cardiology. 74(24):2969-2979, 2019 12 17.PMID: 31574303Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Echocardiography/mt [Methods] | *Heart Failure/co [Complications] | *Mitral Valve Insufficiency/su [Surgery] | *Ventricular Remodeling | Echocardiography/sn [Statistics & Numerical Data] | Humans | Mitral Valve Insufficiency/et [Etiology] | Outcome Assessment, Health Care | Patient SelectionYear: 2019 ISSN:

0735-1097

Name of journal: Journal of the American College of CardiologyAbstract: BACKGROUND: In the COAPT trial among patients with heart failure (HF) and moderate-to-severe (3+) or severe (4+) secondary mitral regurgitation (SMR), patients treated with the transcatheter mitral valve replacement (TMVR) had reduced rates of HF hospitalization and mortality compared with guideline-directed medical therapy (GDMT) alone.CONCLUSIONS: HF patients in the COAPT trial with 3+ or 4+ SMR, selected using strict echocardiographic criteria, benefitted from TMVR with reduced 2-year rates of death and HF hospitalization. Strict application of these echocardiographic criteria should enable the COAPT results to be translated to clinical practice. Copyright (c) 2019. Published by Elsevier Inc.METHODS: A novel echocardiographic algorithm was implemented for grading MR severity during the screening process. Standardized echocardiograms were obtained at baseline and during regular follow-up intervals through 2 years, and analyzed by a core laboratory.OBJECTIVES: To describe the echocardiographic patient qualification process for COAPT, baseline echocardiographic characteristics, changes over time, and the interaction between treatment group and echocardiographic parameters on clinical outcomes.RESULTS: A total of 614 patients were randomized to TMVR plus maximally- tolerated GDMT or GDMT alone. Mean baseline left ventricular ejection fraction (LVEF) was 31.3+/-9.3%, LV end-diastolic volume was 192.7+/-71 ml, and effective regurgitant orifice area was 0.41+/-0.15 cm2. The beneficial effect of TMVR compared with GDMT alone was consistent in all echocardiographic subgroups, independent of the severity of LV dysfunction, LV dilatation, pulmonary hypertension, severity of tricuspid regurgitation or individual MR characteristics. The LVEF decreased and the LV volumes progressively increased in both groups during follow-up, although less after TMVR (P<0.05).All authors: Abraham WT, Asch FM, COAPT Investigators, Grayburn PA, Kar S, Lim DS, Lindenfeld J, Mack MJ, Mishell JM, Siegel RJ, Stone GW, Weissman NJ, Whisenant B, Zaroff JGOriginally published: Journal of the American College of Cardiology. 2019 Sep 19Fiscal year: FY2020Original title: Transcatheter Mitral Valve Replacement in Patients with Heart Failure and Secondary Mitral Regurgitation: From COAPT Trial.Digital Object Identifier:

https://dx.doi.org/10.1016/j.jacc.2019.09.017

Date added to catalog: 2019-10-14

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	31574303	Available		31574303

BACKGROUND: In the COAPT trial among patients with heart failure (HF) and moderate-to-severe (3+) or severe (4+) secondary mitral regurgitation (SMR), patients treated with the transcatheter mitral valve replacement (TMVR) had reduced rates of HF hospitalization and mortality compared with guideline-directed medical therapy (GDMT) alone.

CONCLUSIONS: HF patients in the COAPT trial with 3+ or 4+ SMR, selected using strict echocardiographic criteria, benefitted from TMVR with reduced 2-year rates of death and HF hospitalization. Strict application of these echocardiographic criteria should enable the COAPT results to be translated to clinical practice. Copyright (c) 2019. Published by Elsevier Inc.

METHODS: A novel echocardiographic algorithm was implemented for grading MR severity during the screening process. Standardized echocardiograms were obtained at baseline and during regular follow-up intervals through 2 years, and analyzed by a core laboratory.

OBJECTIVES: To describe the echocardiographic patient qualification process for COAPT, baseline echocardiographic characteristics, changes over time, and the interaction between treatment group and echocardiographic parameters on clinical outcomes.

RESULTS: A total of 614 patients were randomized to TMVR plus maximally- tolerated GDMT or GDMT alone. Mean baseline left ventricular ejection fraction (LVEF) was 31.3+/-9.3%, LV end-diastolic volume was 192.7+/-71 ml, and effective regurgitant orifice area was 0.41+/-0.15 cm2. The beneficial effect of TMVR compared with GDMT alone was consistent in all echocardiographic subgroups, independent of the severity of LV dysfunction, LV dilatation, pulmonary hypertension, severity of tricuspid regurgitation or individual MR characteristics. The LVEF decreased and the LV volumes progressively increased in both groups during follow-up, although less after TMVR (P<0.05).

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