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Journal of the American Society of Echocardiography

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Left Ventricular Global Longitudinal Strain as a Predictor of Outcomes in Patients with Heart Failure with Secondary Mitral Regurgitation: The COAPT Trial - 03/09/21

Doi : 10.1016/j.echo.2021.04.003 
Diego Medvedofsky, MD a, Stephan Milhorini Pio, MD b, Neil J. Weissman, MD a, c, Farnaz Namazi, MD b, Victoria Delgado, MD, PhD b, Paul A. Grayburn, MD d, Saibal Kar, MD e, f, D. Scott Lim, MD g, Stamatios Lerakis, MD h, Zhipeng Zhou, MA i, Mengdan Liu, MS i, Maria C. Alu, MS i, Samir R. Kapadia, MD j, JoAnn Lindenfeld, MD k, William T. Abraham, MD l, Michael J. Mack, MD m, Jeroen J. Bax, MD, PhD b, Gregg W. Stone, MD h, i, Federico M. Asch, MD a, c, ⁎
on Behalf of the

COAPT Investigators

a MedStar Health Research Institute, Washington, District of Columbia 
b Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands 
c Georgetown University, Washington, District of Columbia 
d Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, Texas 
e Los Robles Regional Medical Center, Thousand Oaks, California 
f Bakersfield Heart Hospital, Bakersfield, California 
g Division of Cardiology, University of Virginia, Charlottesville, Virginia 
h The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York 
i Clinical Trials Center, Cardiovascular Research Foundation, New York, New York 
j Cleveland Clinic, Cleveland, Ohio 
k Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee 
l Division of Cardiovascular Medicine, The Ohio State University Medical Center, Columbus, Ohio 
m Baylor Scott & White Health, Plano, Texas 

∗Reprint requests: Federico M. Asch, MD, MedStar Health Research Institute at MedStar Washington Hospital Center, 100 Irving Street, NW, Suite EB 5123, Washington, DC 20010MedStar Health Research Institute at MedStar Washington Hospital Center100 Irving StreetNW, Suite EB 5123WashingtonDC20010

Abstract

Background

Left ventricular (LV) global longitudinal strain (GLS) is a sensitive marker of LV function and may help identify patients with heart failure (HF) and secondary mitral regurgitation who would have a better prognosis and are more likely to benefit from edge-to-edge transcatheter mitral valve repair with the MitraClip. The aim of this study was to assess the prognostic utility of baseline LV GLS during 2-year follow-up of patients with HF with secondary mitral regurgitation enrolled in the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation trial.

Methods

Patients with symptomatic HF with moderate to severe or severe secondary mitral regurgitation who remained symptomatic despite maximally tolerated guideline-directed medical therapy (GDMT) were randomized to transcatheter mitral valve repair plus GDMT or GDMT alone. Speckle-tracking-derived LV GLS from baseline echocardiograms was obtained in 565 patients and categorized in tertiles. Death and HF hospitalization at 2-year follow-up were the principal outcomes of interest.

Results

Patients with better baseline LV GLS had higher blood pressure, greater LV ejection fraction and stroke volume, lower levels of B-type natriuretic peptide, and smaller LV size. No significant difference in outcomes at 2-year follow-up were noted according to LV GLS. However, the rate of death or HF hospitalization between 10 and 24 months was lower in patients with better LV GLS (P = .03), with no differences before 10 months. There was no interaction between GLS tertile and treatment group with respect to 2-year clinical outcomes.

Conclusions

Baseline LV GLS did not predict death or HF hospitalization throughout 2-year follow-up, but it did predict outcomes after 10 months. The benefit of transcatheter mitral valve repair over GDMT alone was consistent in all subgroups irrespective of baseline LV GLS.

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Graphical abstract




Le texte complet de cet article est disponible en PDF.

Highlights

•
In COAPT, worse baseline LV GLS was associated with adverse baseline parameters.
•
Baseline LV GLS did not predict 2-year death or HFH.
•
Patients with worse baseline LV GLS had higher 10-month risk for death or HFH.
•
TMVr (compared with GDMT alone) improved outcomes irrespective of baseline LV GLS.

Le texte complet de cet article est disponible en PDF.

Keywords : Left ventricular global longitudinal strain, Secondary mitral regurgitation, Functional mitral regurgitation, Heart failure, Mortality, COAPT

Abbreviations : COAPT, EROA, GDMT, GLS, HF, HFH, HR, LV, LVEDV, LVEF, LVESV, MR, SMR, STE, TMVr


Plan


 The COAPT trial was sponsored by Abbott Vascular (Santa Clara, CA) and designed collaboratively by the principal investigators and the sponsor. Data analysis was performed entirely by the investigators.
 Drs. Asch and Weissman are director and associate director, respectively, of an academic echocardiography core laboratory (MedStar Health Research Institute) with institutional contracts with Abbott, Boston Scientific, Edwards Lifesciences, Neovasc, Ancora, Mitralign, MVRx, InnovHeart, Polares Medical, Medtronic, Biotronik, and LivaNova. Dr. Pio has received research grant support from Abbott Vascular. Dr. Namazi has received research grant support from Abbott Vascular. Dr. Delgado has received research grants from Abbott Vascular, Bayer, BioVentrix, Biotronik, Boston Scientific, Edwards Lifesciences, GE Healthcare, and Medtronic; and has received speaking fees from Abbott Vascular, Edwards Lifesciences, Medtronic, Merck Sharpe & Dohme, and GE Healthcare. Dr. Grayburn has received research grant support from Abbott, Edwards Lifesciences, Medtronic, and Boston Scientific; is a consultant for Abbott, Edwards, Medtronic, and NeoChord; and has imaging core laboratory contracts with Edwards Lifesciences, NeoChord, W. L. Gore, and Cardiovalve. Dr. Kar has received research grant support from Abbott, Boston Scientific, Edwards Lifesciences, and Mitralign; and has received consulting income from Abbott and Boston Scientific. Dr. Lim has received research grant support from Abbott; and has received consulting income from Abbott. Dr. Lindenfeld has received research grant support from AstraZeneca; and has received consulting income from Abbott, Edwards Lifesciences, Boston Scientific, Relypsa, Boehringer Ingelheim, V-Wave, CVRx, and Impulse Dynamics. Dr. Abraham has received research grant support from Abbott; and has received consulting income from Abbott. Dr. Mack has nonfinancial relationships with Edwards Lifesciences (co–principal investigator of the PARTNER 3 trial), Abbott (co–principal investigator of the COAPT trial), and Medtronic (study chairman of the APOLLO trial). Dr. Bax has received research grants from Abbott Vascular, Bayer, BioVentrix, Biotronik, Boston Scientific, Edwards Lifesciences, GE Healthcare, and Medtronic; and has received speaker fees from Abbott Vascular. Dr. Stone has received speaking or other honoraria from Cook, Terumo, Qool Therapeutics, and Orchestra BioMed; is a consultant to Valfix, TherOx, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Miracor, Neovasc, V-Wave, Abiomed, Ancora, MAIA Pharmaceuticals, Vectorious, Reva, Matrizyme, and CardioMech; holds equity or options with Ancora, Qool Therapeutics, Cagent, Applied Therapeutics, the BioStar family of funds, SpectraWave, Orchestra BioMed, Aria, Cardiac Success, the MedFocus family of funds, and Valfix.


© 2021  American Society of Echocardiography. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 34 - N° 9

P. 955-965 - septembre 2021 Retour au numéro
Article précédent Article précédent
  • Ratio between Vena Contracta Width and Tricuspid Annular Diameter: Prognostic Value in Secondary Tricuspid Regurgitation
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