Department of Cardiology Leiden University Medical Center Leiden the Netherlands.
MedStar Health Research Institute Washington DC USA.
J Am Heart Assoc. 2023 Sep 5;12(17):e029956. doi: 10.1161/JAHA.122.029956. Epub 2023 Aug 30.
Background Left ventricular (LV) global longitudinal strain (GLS) provides incremental prognostic information over LV ejection fraction in patients with heart failure (HF) and secondary mitral regurgitation. We examined the prognostic impact of LV GLS improvement in this population. Methods and Results The COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial randomized symptomatic patients with HF with severe (3+/4+) mitral regurgitation to transcatheter edge-to-edge repair with the MitraClip device plus maximally tolerated guideline-directed medical therapy (GDMT) versus GDMT alone. LV GLS was measured at baseline and 6-month follow-up. The relationship between the improvement in LV GLS from baseline to 6 months and the composite of all-cause death or HF hospitalization between 6- and 24-month follow-up were assessed. Among 383 patients, 174 (45.4%) had improved LV GLS at 6-month follow-up (83/195 [42.6%] with transcatheter edge-to-edge repair+GDMT and 91/188 [48.4%] with GDMT alone; =0.25). Improvement in LV GLS was strongly associated with reduced death or HF hospitalization between 6 and 24 months (<0.009), with similar risk reduction in both treatment arms (=0.40). By multivariable analysis, LV GLS improvement at 6 months was independently associated with a lower risk of death or HF hospitalization (hazard ratio [HR], 0.55 [95% CI, 0.36-0.83]; =0.009), death (HR, 0.48 [95% CI, 0.29-0.81]; =0.006), and HF hospitalization (HR, 0.50 [95% CI, 0.31-0.81]; =0.005) between 6 and 24 months. Conclusions Among patients with HF and severe mitral regurgitation in the COAPT trial, improvement in LV GLS at 6-month follow-up was associated with improved outcomes after both transcatheter edge-to-edge repair and GDMT alone between 6 and 24 months. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01626079.
左心室（LV）整体纵向应变（GLS）为心力衰竭（HF）和继发性二尖瓣反流患者提供了比 LV 射血分数更具增量预后信息。我们研究了该人群中 LV GLS 改善的预后影响。
COAPT（经导管二尖瓣夹合术治疗有功能性二尖瓣反流的心力衰竭患者的心血管结局评估）试验将症状性 HF 伴严重（3+/4+）二尖瓣反流患者随机分为经导管缘对缘修复联合最大耐受指南导向的药物治疗（GDMT）与 GDMT 治疗组。在基线和 6 个月随访时测量 LV GLS。评估从基线到 6 个月 LV GLS 改善与 6-24 个月随访期间全因死亡或 HF 住院的复合终点之间的关系。在 383 例患者中，174 例（45.4%）在 6 个月随访时 LV GLS 改善（经导管缘对缘修复+GDMT 组 83/195 [42.6%]，GDMT 组 91/188 [48.4%]；=0.25）。LV GLS 的改善与 6-24 个月时的死亡或 HF 住院风险降低显著相关（<0.009），并且在两种治疗组中均有相似的风险降低（=0.40）。多变量分析显示，6 个月时 LV GLS 改善与死亡或 HF 住院风险降低相关（风险比[HR]，0.55 [95%CI，0.36-0.83]；=0.009），与死亡（HR，0.48 [95%CI，0.29-0.81]；=0.006）和 HF 住院（HR，0.50 [95%CI，0.31-0.81]；=0.005）风险降低相关。
在 COAPT 试验中，HF 伴严重二尖瓣反流患者 6 个月随访时 LV GLS 的改善与 6-24 个月时经导管缘对缘修复和 GDMT 单独治疗后改善的结局相关。
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