Pulmonary Hypertension in Transcatheter Mitral Valve Repair for Secondary Mitral Regurgitation: The COAPT Trial.
Citation: Journal of the American College of Cardiology. 76(22):2595-2606, 2020 12 01.PMID: 33243380Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, Non-U.S. Gov'tSubject headings: *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 OutcomeYear: 2020Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:- 0735-1097
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
---|---|---|---|---|---|---|
Journal Article | MedStar Authors Catalog | Article | 33243380 | Available | 33243380 |
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