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Sex-Specific Outcomes of Transcatheter Mitral-Valve Repair and Medical Therapy for Mitral Regurgitation in

Ioanna Kosmidou1, JoAnn Lindenfeld2, William T Abraham3

  • 1NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.

JACC. Heart Failure
|August 15, 2021
PubMed

Insights

Transcatheter mitral valve repair (TMVr) improved heart failure outcomes, but its benefit in reducing hospitalizations was less pronounced in women than men after the first year. TMVr consistently reduced mortality for both sexes in the COAPT trial.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Heart Failure Management

Background:

  • Severe secondary mitral regurgitation (SMR) in heart failure (HF) patients poses significant challenges.
  • The impact of sex on treatment outcomes for SMR with transcatheter mitral valve repair (TMVr) remains largely unexplored.

Purpose of the Study:

  • To evaluate sex-specific outcomes in patients with HF and severe SMR treated with TMVr plus guideline-directed medical therapy (GDMT) versus GDMT alone.
  • To analyze the differential effects of TMVr on heart failure hospitalizations and mortality between men and women within the COAPT trial.

Main Methods:

  • Randomized controlled trial (COAPT) comparing TMVr plus GDMT versus GDMT alone.
  • Analysis of 2-year outcomes stratified by sex, including heart failure hospitalizations (HFH) and mortality.
  • Utilized a joint frailty model to account for competing risks.

Main Results:

  • Women were younger with fewer comorbidities but had lower baseline quality of life and functional capacity.
  • While GDMT alone showed higher HFH in men, TMVr demonstrated a greater relative reduction in HFH for men compared to women (Pinteraction=0.002).
  • TMVr consistently reduced 2-year mortality irrespective of sex (Pinteraction=0.99), with female sex independently associated with lower adjusted mortality risk.

Conclusions:

  • TMVr with MitraClip improved clinical outcomes in HF patients with SMR, regardless of sex.
  • The reduction in HFH with TMVr was less pronounced in women than men beyond the first year post-treatment.
  • While mortality benefits were consistent across sexes, further investigation into sex-specific HFH responses to TMVr is warranted.
Abstract

Keywords:
heart failuremortalitysextranscutaneous mitral valve repair

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