Page 113 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation

Limitations
As a post hoc analysis the present results should be considered exploratory and hypothesis generating. The potential impact of unmeasured confounders cannot be excluded; thus, demonstrating associations in multivariable analysis does not prove causality. The operators participating in COAPT in general were very experienced; similar results may not be achieved by operators who have not yet traversed the learning curve (32). Not all echocardiographic parameters of interest were assessed in the present study, and additional insights might have been gained by 3D echocardiographic assessment (33). Finally, by protocol patients with marked LV dysfunction were excluded, some pathologies (e.g. P3 tethering) were infrequently present, and of course the results apply solely to treatment of functional MR. Further studies are thus warranted to examine the prognostic implications of mitral valve anatomies not included in the present study.
Conclusions
In the present echocardiographic core laboratory study from the multicenter COAPT trial, among HF patients with 3+ or 4+ secondary MR, a large anteroposterior mitral annular diameter was associated with increased risk of the composite outcome of all- cause death or HFH and HFH alone. Greater EROA was an independent predictor of mortality. Treatment with the MitraClip plus GDMT compared with GDMT lone reduced death and HFH consistently in patients with and without these extremes.
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