التفاصيل البيبلوغرافية
| العنوان: |
Relationship Between Residual Mitral Regurgitation and Clinical and Quality-of-Life Outcomes After Transcatheter and Medical Treatments in Heart Failure: COAPT Trial. |
| المؤلفون: |
Kar, Saibal1,2, Mack, Michael J.3, Lindenfeld, JoAnn4, Abraham, William T.5, Asch, Federico M.6,7, Weissman, Neil J.6,7, Enriquez-Sarano, Maurice8, Scott Lim, D.9, Mishell, Jacob M.10, Whisenant, Brian K.11, Rogers, Jason H.12, Arnold, Suzanne V.13,14, Cohen, David J.15,16, Grayburn, Paul A.17, Stone, Gregg W.16,18 gregg.stone@mountsinai.org, Lim, D Scott19 (AUTHOR) |
| المصدر: |
Circulation. 8/10/2021, Vol. 144 Issue 6, p426-437. 12p. |
| مصطلحات موضوعية: |
*MITRAL valve insufficiency, *HEART failure, *TREATMENT failure, *TREATMENT effectiveness, *THERAPEUTICS, *HEART failure patients, *QUALITY of life, *HEART failure treatment, *CARDIAC catheterization, *PUBLIC health surveillance, *RESEARCH, *CLINICAL trials, *TIME, *RESEARCH methodology, *PROGNOSIS, *MEDICAL cooperation, *EVALUATION research, *SEVERITY of illness index, *COMPARATIVE studies, *PROSTHETIC heart valves, *QUESTIONNAIRES, *DISEASE complications |
| مستخلص: |
Background: In the randomized COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation), among 614 patients with heart failure with 3+ or 4+ secondary mitral regurgitation (MR), transcatheter mitral valve repair (TMVr) with the MitraClip reduced MR, heart failure hospitalizations, and mortality and improved quality of life compared with guideline-directed medical therapy (GDMT) alone. We aimed to examine the prognostic relationship between MR reduction and outcomes after TMVr and GDMT alone.Methods: Outcomes in COAPT between 30 days and 2 years were examined on the basis of the severity of residual MR at 30 days.Results: TMVr-treated patients had less severe residual MR at 30 days than GDMT-treated patients (0/1+, 2+, and 3+/4+: 72.9%, 19.9%, and 7.2% versus 8.2%, 26.1%, and 65.8%, respectively [P<0.0001]). The rate of composite death or heart failure hospitalizations between 30 days and 2 years was lower in patients with 30-day residual MR of 0/1+ and 2+ compared with patients with 30-day residual MR of 3+/4+ (37.7% versus 49.5% versus 72.2%, respectively [P<0.0001]). This relationship was consistent in the TMVr and GDMT arms (Pinteraction=0.92). The improvement in Kansas City Cardiomyopathy Questionnaire score from baseline to 30 days was maintained between 30 days and 2 years in patients with 30-day MR ≤2+ but deteriorated in those with 30-day MR 3+/4+ (-0.3±1.7 versus -9.4±4.6 [P=0.0008]) consistently in both groups (Pinteraction=0.95).Conclusions: In the COAPT trial, reduced MR at 30 days was associated with greater freedom from death or heart failure hospitalizations and improved quality of life through 2-year follow-up whether the MR reduction was achieved by TMVr or GDMT. Registration: URL: https://www.clinicaltrials.govTest; Unique identifier: NCT01626079. [ABSTRACT FROM AUTHOR] |
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