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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
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Echocardiographic Outcomes After Transcatheter Leaflet Approximation in Patients With Secondary Mitral Regurgitation:

Federico M Asch1, Paul A Grayburn2, Robert J Siegel3

  • 1Cardiovascular Core Laboratories, MedStar Health Research Institute, Washington, DC.

Journal of the American College of Cardiology
|October 2, 2019
PubMed

Insights

Transcatheter mitral valve repair (TMVr) in heart failure patients with secondary mitral regurgitation significantly reduced hospitalizations and mortality. Strict echocardiographic criteria ensured consistent benefits across patient subgroups.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • The COAPT trial investigated transcatheter mitral valve repair (TMVr) versus guideline-directed medical therapy (GDMT) for heart failure (HF) patients with moderate-to-severe or severe secondary mitral regurgitation.
  • TMVr via leaflet approximation demonstrated reduced HF hospitalization and mortality compared to GDMT alone.

Purpose of the Study:

  • To detail the echocardiographic qualification process for COAPT trial participants.
  • To analyze baseline and longitudinal echocardiographic characteristics.
  • To assess the impact of echocardiographic parameters and treatment on clinical outcomes.

Main Methods:

  • A novel echocardiographic algorithm was used for mitral regurgitation severity grading during screening.
  • Standardized echocardiograms were acquired at baseline and up to 2-year follow-up.
  • A core laboratory analyzed all echocardiographic data.

Main Results:

  • 614 patients were randomized to TMVr + GDMT or GDMT alone.
  • Mean baseline LV ejection fraction was 31.3%, LV end-diastolic volume 192.7 ml, and effective regurgitant orifice area 0.41 cm².
  • TMVr benefits were consistent across echocardiographic subgroups, irrespective of LV dysfunction, dilatation, or pulmonary hypertension. LV ejection fraction decreased and volumes increased less with TMVr.

Conclusions:

  • HF patients with severe secondary mitral regurgitation, selected via strict echocardiographic criteria in the COAPT trial, experienced reduced mortality and HF hospitalizations with TMVr.
  • Adherence to these echocardiographic criteria is crucial for translating COAPT trial findings into clinical practice.
Abstract

Keywords:
MitraClipclinical outcomesechocardiographyheart failuremitral valve edge-to-edge repairpercutaneous mitral valve repairsecondary mitral regurgitation

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