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

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:74

Article

Asch, Federico M.¹  Grayburn, Paul A.²  Siegel, Robert J.³  Kar, Saibal³  Lim, D. Scott⁴  Zaroff, Jonathan G.⁵  Mishell, Jacob M.⁵  Whisenant, Brian⁶  Mack, Michael J.⁷  Lindenfeld, Joann⁸  Abraham, William T.^9,10,11,12  Stone, Gregg W.^13,14  Weissman, Neil J.¹ 

[1] MedStar Hlth Res Inst, Cardiovasc Core Labs, Washington, DC USA

[2] Baylor Univ, Med Ctr, Baylor Heart & Vasc Inst, Dallas, TX USA

[3] Cedars Sinai Smidt Heart Inst, Los Angeles, CA USA

[4] Univ Virginia, Div Cardiol, Charlottesville, VA USA

[5] Kaiser Permanente, San Francisco Hosp, San Francisco, CA USA

[6] Intermt Med Ctr, Murray, UT USA

[7] Baylor Scott & White Heart & Vasc Hosp, Plano, TX USA

[8] Vanderbilt Heart & Vasc Inst, Adv Heart Failure, Nashville, TN USA

[9] Ohio State Univ, Dept Med, Div Cardiovasc Med, Columbus, OH 43210 USA

[10] Ohio State Univ, Dept Physiol, Div Cardiovasc Med, Columbus, OH 43210 USA

[11] Ohio State Univ, Dept Cell Biol, Div Cardiovasc Med, Columbus, OH 43210 USA

[12] Ohio State Univ, Davis Heart & Lung Res Inst, Columbus, OH 43210 USA

[13] Icahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY 10029 USA

[14] Cardiovasc Res Fdn, New York, NY USA

关键词: clinical outcomes;    echocardiography;    heart failure;    MitraClip;    mitral valve edge-to-edge repair;    percutaneous mitral valve repair;    secondary mitral regurgitation;   

DOI  :  10.1016/j.jacc.2019.09.017

来源: Elsevier

【 摘 要 】

BACKGROUND In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial among patients with heart failure (HF) and moderate-to-severe (3+) or severe (4+) secondary mitral regurgitation, patients treated with transcatheter mitral valve repair (TMVr) through leaflet approximation had reduced rates of HF hospitalization and mortality compared with guideline-directed medical therapy (GDMT) alone. OBJECTIVES The purpose of this study was to describe the echocardiographic patient qualification process for the COAPT trial, baseline echocardiographic characteristics, changes over time, and the interaction between treatment group and echocardiographic parameters on clinical outcomes. METHODS A novel echocardiographic algorithm was implemented for grading mitral regurgitation severity during the screening process. Standardized echocardiograms were obtained at baseline and during regular follow-up intervals through 2 years, and were analyzed by a core laboratory. RESULTS A total of 614 patients were randomized to TMVr plus maximally tolerated GDMT or GDMT alone. Mean baseline left ventricular (LV) ejection fraction was 31.3 +/- 9.3%, LV end-diastolic volume was 192.7 +/- 71 ml, and effective regurgitant orifice area was 0.41 +/- 0.15 cm(2). 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 mitral regurgitation characteristics. The LV ejection fraction decreased and the LV volumes progressively increased in both groups during follow-up, although less after TMVr (p < 0.05). CONCLUSIONS HF patients in the COAPT trial with 3+ or 4+ secondary mitral regurgitation, 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. (C) 2019 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

【 授权许可】

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