Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Cardiovascular Core Laboratories, MedStar Health Research Institute, Washington, District of Columbia, USA.
JACC Cardiovasc Interv. 2023 May 22;16(10):1160-1172. doi: 10.1016/j.jcin.2023.02.031.
The relationship between left ventricular (LV) remodeling and clinical outcomes after treatment of severe mitral regurgitation (MR) in heart failure (HF) has not been examined.
The aim of this study was to evaluate the association between LV reverse remodeling and subsequent outcomes and assess whether transcatheter edge-to-edge repair (TEER) and residual MR are associated with LV remodeling in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial.
Patients with HF and severe MR who remained symptomatic on guideline-directed medical therapy (GDMT) were randomized to TEER plus GDMT or GDMT alone. Baseline and 6-month core laboratory measurements of LV end-diastolic volume index and LV end-systolic volume index were examined. Change in LV volumes from baseline to 6 months and clinical outcomes from 6 months to 2 years were evaluated using multivariable regression.
The analytical cohort comprised 348 patients (190 treated with TEER, 158 treated with GDMT alone). A decrease in LV end-diastolic volume index at 6 months was associated with reduced cardiovascular death between 6 months and 2 years (adjusted HR: 0.90 per 10 mL/m decrease; 95% CI: 0.81-1.00; P = 0.04), with consistent results in both treatment groups (P = 0.26). Directionally similar but nonsignificant relationships were present for all-cause death and HF hospitalization and between reduced LV end-systolic volume index and all outcomes. Neither treatment group nor MR severity at 30 days was associated with LV remodeling at 6 or 12 months. The treatment benefits of TEER were not significant regardless of the degree of LV remodeling at 6 months.
In patients with HF and severe MR, LV reverse remodeling at 6 months was associated with subsequently improved 2-year outcomes but was not affected by TEER or the extent of residual MR. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial] and COAPT CAS [COAPT]; NCT01626079).
左心室（LV）重构与心力衰竭（HF）患者重度二尖瓣反流（MR）治疗后的临床结局之间的关系尚未得到检验。
本研究旨在评估 LV 逆重构与随后的结局之间的关系，并评估经导管缘对缘修复（TEER）和残余 MR 是否与 COAPT（经皮治疗心力衰竭伴功能性二尖瓣反流患者的二尖瓣夹合器心血管结局评估）试验中的 LV 重构相关。
对仍在接受指南指导的药物治疗（GDMT）的 HF 和重度 MR 患者进行随机分组，分别接受 TEER 加 GDMT 或 GDMT 治疗。检查 LV 舒张末期容积指数和 LV 收缩末期容积指数的基线和 6 个月时的核心实验室测量值。使用多变量回归评估从基线到 6 个月的 LV 容积变化和从 6 个月到 2 年的临床结局。
分析队列包括 348 例患者（190 例接受 TEER 治疗，158 例单独接受 GDMT 治疗）。6 个月时 LV 舒张末期容积指数降低与 6 个月至 2 年期间心血管死亡减少相关（调整后的 HR：每降低 10 mL/m 减少 0.90；95%CI：0.81-1.00；P=0.04），两组治疗均有类似的结果（P=0.26）。全因死亡和 HF 住院率的相关性呈相似但无统计学意义，LV 收缩末期容积指数降低与所有结局的相关性呈相似但无统计学意义。30 天时的治疗组和 MR 严重程度与 6 个月或 12 个月时的 LV 重构均无相关性。无论 6 个月时 LV 重构的程度如何，TEER 的治疗益处均不显著。
在 HF 和重度 MR 患者中，6 个月时的 LV 逆重构与随后的 2 年结局改善相关，但不受 TEER 或残余 MR 程度的影响。（心力衰竭伴功能性二尖瓣反流患者的经皮治疗二尖瓣夹合器的心血管结局评估[COAPT 试验]和 COAPT CAS[COAPT]；NCT01626079）。
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