Page 96 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation
P. 96

Chapter five. MV geometry: The COAPT Trial
Abstract
Aims
The impact of mitral valve geometry on outcomes after MitraClip treatment in secondary MR has not been examined. We therefore sought to evaluate the association between mitral valve geometry and outcomes of patients with heart failure (HF) and secondary mitral regurgitation (MR) treated with guideline-directed medical therapy (GDMT) and MitraClip.
Methods and Results
Mitral valve geometry was assessed from the baseline echocardiograms in 614 patients from the COAPT trial. The primary endpoint for the present study was the composite of all-cause mortality or HF hospitalization (HFH) within 2 years. Effect of treatment arm (MitraClip plus maximally-tolerated GDMT versus GDMT alone) on outcomes according to baseline variables was assessed.
Among 29 baseline mitral valve echocardiographic parameters, increasing antero- posterior mitral annular diameter was the only independent predictor of the composite endpoint of all-cause mortality or HFH (adjusted hazard ratio (aHR) per cm 1.49; p=0.04). The effective regurgitant orifice area (EROA) was independently associated with all-cause mortality alone (aHR per cm2 2.97; p=0.04) but not with HFH, whereas increasing anteroposterior mitral annular diameter was independently associated with HFH alone (aHR per cm 1.85; p=0.005) but not all-cause mortality. Other mitral valve morphologic parameters were unrelated to outcomes. MitraClip reduced HFH and mortality independent of anteroposterior mitral annular diameter and EROA (Pinteraction= 0.77 and 0.27 respectively).
Conclusion
In patients with HF and severe secondary MR, a large anteroposterior mitral annular diameter and greater EROA were the strongest echocardiographic predictors of HFH and death in patients treated with GDMT alone and with the MitraClip.
94

























































































   94   95   96   97   98