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Baseline Functional Capacity and Transcatheter Mitral Valve Repair in Heart Failure With Secondary Mitral Regurgitation
- Source :
- JACC: Cardiovascular Interventions. 13:2331-2341
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- The aim of this study was to determine the prognostic utility of baseline functional status and its impact on the outcomes of transcatheter mitral valve repair (TMVr) in patients with heart failure (HF) with secondary mitral regurgitation (SMR).The COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial demonstrated that TMVr with the MitraClip in patients with HF with moderate to severe or severe SMR improved health-related quality of life. The clinical utility of a baseline assessment of functional status for evaluating prognosis and identifying candidates likely to derive a robust benefit from TMVr has not been previously studied in patients with HF with SMR.The COAPT study was a multicenter, randomized, controlled, parallel-group, open-label trial of TMVr with the MitraClip plus guideline-directed medical therapy (GDMT) versus GDMT alone in patients with HF, left ventricular ejection fraction 20% to 50%, and moderate to severe or severe SMR. Baseline functional status was assessed by 6-min walk distance (6MWD).Patients with 6MWD less than the median (240 m) were older, were more likely to be female, and had more comorbidities. After multivariate modeling, age (p = 0.005), baseline hemoglobin (p = 0.007), and New York Heart Association functional class III/IV symptoms (p 0.0001) were independent clinical predictors of 6MWD. Patients with 6MWD 240 m versus ≥240 m had a higher unadjusted and adjusted rate of the 2-year composite of all-cause death or HF hospitalization (64.4% vs. 48.6%; adjusted hazard ratio: 1.53; 95% confidence interval: 1.19 to 1.98; p = 0.001). However, there was no interaction between baseline 6MWD and the relative effectiveness of TMVr plus GDMT versus GDMT alone with respect to the composite endpoint (p = 0.633).Baseline assessment of functional capacity by 6MWD was a powerful discriminator of prognosis in patients with HF with SMR. TMVr with the MitraClip provided substantial improvements in clinical outcomes for this population irrespective of baseline functional capacity.
- Subjects :
- Male
medicine.medical_specialty
Population
030204 cardiovascular system & hematology
Ventricular Function, Left
03 medical and health sciences
0302 clinical medicine
Quality of life
Internal medicine
medicine
Humans
In patient
030212 general & internal medicine
education
Heart Failure
Heart Valve Prosthesis Implantation
Mitral regurgitation
education.field_of_study
Ejection fraction
business.industry
MitraClip
Mitral Valve Insufficiency
Stroke Volume
medicine.disease
Treatment Outcome
Heart failure
Quality of Life
Cardiology
Mitral Valve
Female
Transcatheter mitral valve repair
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 19368798
- Volume :
- 13
- Database :
- OpenAIRE
- Journal :
- JACC: Cardiovascular Interventions
- Accession number :
- edsair.doi.dedup.....b4cbfba6e595f535e3558c6a60966a62