Changes in Left Ventricular Function and Outcomes After Trancatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation

Stamatios Lerakis, Annapoorna S. Kini, Gennaro Giustino, Malcolm Anastasius, Federico M. Asch, Neil J. Weissman, Paul A. Grayburn, Saibal Kar, D. Scott Lim, Jacob M. Mishell, Brian K. Whisenant, Michael J. Rinaldi, Samir R. Kapadia, Vivek Rajagopal, Ian J. Sarembock, Andreas Brieke, Gilbert H.L. Tang, Yanru Li, Maria C. Alu, Jo Ann LindenfeldWilliam T. Abraham, Samin K. Sharma, Michael J. Mack, Gregg W. Stone

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Transcatheter edge-to-edge repair (TEER) improved outcomes in patients with heart failure (HF) and severe secondary mitral regurgitation (SMR) compared with guideline-directed medical therapy (GDMT) alone regardless of the severity of baseline left ventricular ejection fraction (LVEF). The study aimed to evaluate the effect of early changes in LVEF after TEER and GDMT alone in patients with HF and severe SMR. Methods: Within the COAPT trial, we evaluated outcomes according to changes in LVEF from baseline to 30 days. The primary outcome was all-cause death or HF hospitalization (HFH) between 30 days and 2 years. Results: Among 432 patients with paired echocardiographic data, 182 (42.1%) had increased LVEF (LVEF change 6.0% ± 4.9%) and 250 (57.9%) had a decrease or no change in LVEF (LVEF change –6.6% ± 5.6%) from baseline to 30 days. LVEF at 30 days increased more frequently with GDMT alone compared with TEER plus GDMT (51.4% vs 33.0%; P = .0001). Between 30 days and 2 years, there were no significant differences in death or HFH in the increase LVEF and the decrease LVEF groups (58.8% vs 51.4%; multivariable-adjusted HR, 0.97; 95% CI, 0.87-1.08; P = .59). TEER plus GDMT reduced the 30-day to 2-year rate of death or HFH compared with GDMT alone consistently in patients with increase LVEF and decrease LVEF (Pint = 0.75). Conclusions: Among patients with HF and severe SMR, early improvements in LVEF were more frequent with GDMT alone compared with TEER plus GDMT but were not associated with subsequent outcomes at 2 years. TEER reduced death or HFH during 2-year follow-up irrespective of early LVEF changes.

Original languageEnglish
Article number101345
JournalJournal of the Society for Cardiovascular Angiography and Interventions
Volume3
Issue number5
DOIs
StatePublished - May 2024

Keywords

  • GDMT
  • TEER
  • guideline-directed medical therapy
  • left ventricular ejection fraction
  • secondary mitral regurgitation
  • transcatheter edge-to-edge repair

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