Pulmonary Hypertension in Transcatheter Mitral Valve Repair for Secondary Mitral Regurgitation: The COAPT Trial. Academic Article uri icon

Overview

abstract

  • BACKGROUND: Pulmonary hypertension worsens prognosis in patients with heart failure (HF) and secondary mitral regurgitation (SMR). OBJECTIVES: This study sought to determine whether baseline pulmonary hypertension influences outcomes of transcatheter mitral valve repair (TMVr) in patients with HF with SMR. 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). 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). 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.

authors

  • Ben-Yehuda, Ori
  • Shahim, Bahira
  • Chen, Shmuel
  • Liu, Mengdan
  • Redfors, Bjorn
  • Hahn, Rebecca T
  • Asch, Federico M
  • Weissman, Neil J
  • Medvedofsky, Diego
  • Puri, Rishi
  • Kapadia, Samir
  • Sannino, Anna
  • Grayburn, Paul
  • Kar, Saibal
  • Lim, Scott
  • Lindenfeld, JoAnn
  • Abraham, William T
  • Mack, Michael J
  • Stone, Gregg W

publication date

  • December 1, 2020

Research

keywords

  • Cardiac Catheterization
  • Heart Failure
  • Heart Valve Prosthesis Implantation
  • Hypertension, Pulmonary
  • Mitral Valve
  • Mitral Valve Insufficiency
  • Postoperative Complications

Identity

Scopus Document Identifier

  • 85096511555

Digital Object Identifier (DOI)

  • 10.1016/j.jacc.2020.09.609

PubMed ID

  • 33243380

Additional Document Info

volume

  • 76

issue

  • 22