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Impact of Diabetes on Outcomes After Transcatheter Mitral Valve Repair in Heart Failure: COAPT Trial

Bahira Shahim1, Ori Ben-Yehuda2, Shmuel Chen3

  • 1Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.

JACC. Heart Failure
|July 30, 2021
PubMed

Insights

Diabetes worsens outcomes in heart failure patients with secondary mitral regurgitation. However, transcatheter mitral valve repair (TMVr) with MitraClip consistently reduced death and heart failure hospitalizations in both diabetic and non-diabetic patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Heart Failure Management

Background:

  • Diabetes is a known risk factor for adverse outcomes in patients with heart failure (HF).
  • The impact of diabetes on the efficacy of transcatheter mitral valve repair (TMVr) for secondary mitral regurgitation (SMR) remains an important clinical question.

Purpose of the Study:

  • To investigate whether diabetes influences the outcomes of TMVr in patients with HF and SMR.
  • To evaluate the effectiveness of TMVr in diabetic versus non-diabetic patients.

Main Methods:

  • Analysis of data from the COAPT trial, which randomized HF patients with severe SMR to MitraClip plus guideline-directed medical therapy (GDMT) or GDMT alone.
  • Comparison of 2-year outcomes, including mortality and HF hospitalization, between patients with and without diabetes.

Main Results:

  • Diabetic patients (37.3%) had higher 2-year mortality rates compared to non-diabetic patients (40.8% vs 32.3%).
  • TMVr consistently reduced 2-year death rates (HR 0.51 in diabetics, HR 0.57 in non-diabetics) and HF hospitalization rates (HR 0.41 in diabetics, HR 0.54 in non-diabetics) regardless of diabetic status.
  • Improvements in quality of life and exercise capacity were observed with TMVr in both groups.

Conclusions:

  • Diabetic patients with severe SMR and HF have a worse prognosis.
  • TMVr using MitraClip provides consistent benefits in reducing mortality, HF hospitalizations, and improving quality of life and functional capacity in both diabetic and non-diabetic patients.
Abstract

Keywords:
diabetesheart failuremitral regurgitationtranscatheter mitral valve repair

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