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Changes in Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial
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 RES...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10547326/ https://www.ncbi.nlm.nih.gov/pubmed/37646214 http://dx.doi.org/10.1161/JAHA.122.029956 |
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author | Pio, Stephan M. Medvedofsky, Diego Stassen, Jan Delgado, Victoria Namazi, Farnaz Weissman, Neil J. Grayburn, Paul Kar, Saibal Lim, D. Scott Zhou, Zhipeng Alu, Maria C. Redfors, Björn Kapadia, Samir Lindenfeld, JoAnn Abraham, William T. Mack, Michael J. Asch, Federico M. Stone, Gregg W. Bax, Jeroen J. |
author_facet | Pio, Stephan M. Medvedofsky, Diego Stassen, Jan Delgado, Victoria Namazi, Farnaz Weissman, Neil J. Grayburn, Paul Kar, Saibal Lim, D. Scott Zhou, Zhipeng Alu, Maria C. Redfors, Björn Kapadia, Samir Lindenfeld, JoAnn Abraham, William T. Mack, Michael J. Asch, Federico M. Stone, Gregg W. Bax, Jeroen J. |
author_sort | Pio, Stephan M. |
collection | PubMed |
description | 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; P=0.25). Improvement in LV GLS was strongly associated with reduced death or HF hospitalization between 6 and 24 months (P<0.009), with similar risk reduction in both treatment arms (P (interaction)=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]; P=0.009), death (HR, 0.48 [95% CI, 0.29–0.81]; P=0.006), and HF hospitalization (HR, 0.50 [95% CI, 0.31–0.81]; P=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. |
format | Online Article Text |
id | pubmed-10547326 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-105473262023-10-04 Changes in Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial Pio, Stephan M. Medvedofsky, Diego Stassen, Jan Delgado, Victoria Namazi, Farnaz Weissman, Neil J. Grayburn, Paul Kar, Saibal Lim, D. Scott Zhou, Zhipeng Alu, Maria C. Redfors, Björn Kapadia, Samir Lindenfeld, JoAnn Abraham, William T. Mack, Michael J. Asch, Federico M. Stone, Gregg W. Bax, Jeroen J. J Am Heart Assoc Original Research 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; P=0.25). Improvement in LV GLS was strongly associated with reduced death or HF hospitalization between 6 and 24 months (P<0.009), with similar risk reduction in both treatment arms (P (interaction)=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]; P=0.009), death (HR, 0.48 [95% CI, 0.29–0.81]; P=0.006), and HF hospitalization (HR, 0.50 [95% CI, 0.31–0.81]; P=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. John Wiley and Sons Inc. 2023-08-30 /pmc/articles/PMC10547326/ /pubmed/37646214 http://dx.doi.org/10.1161/JAHA.122.029956 Text en © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Research Pio, Stephan M. Medvedofsky, Diego Stassen, Jan Delgado, Victoria Namazi, Farnaz Weissman, Neil J. Grayburn, Paul Kar, Saibal Lim, D. Scott Zhou, Zhipeng Alu, Maria C. Redfors, Björn Kapadia, Samir Lindenfeld, JoAnn Abraham, William T. Mack, Michael J. Asch, Federico M. Stone, Gregg W. Bax, Jeroen J. Changes in Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial |
title | Changes in Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial |
title_full | Changes in Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial |
title_fullStr | Changes in Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial |
title_full_unstemmed | Changes in Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial |
title_short | Changes in Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial |
title_sort | changes in left ventricular global longitudinal strain in patients with heart failure and secondary mitral regurgitation: the coapt trial |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10547326/ https://www.ncbi.nlm.nih.gov/pubmed/37646214 http://dx.doi.org/10.1161/JAHA.122.029956 |
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