Elevated pulmonary artery systolic pressure (PASP) was found to be associated with a worse prognosis in patients with heart failure with severe secondary mitral regurgitation (SMR), according to a study published in the Journal of the American College of Cardiology.
Researchers sought to determine whether baseline pulmonary hypertension influences the outcomes of TMVr in patients with heart failure and SMR in the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation trial.
A total of 614 patients (mean age, 72.1 ± 11.5 years; 63.1% men; mean left ventricular ejection fraction, 31.6± 9.4%) with heart failure and moderate to severe or severe SMR were randomly assigned to receive transcatheter mitral valve repair (TMVr) with the MitraClip (Abbott, Santa Clara, CA) and guideline-directed medical therapy (GDMT; n=302) or GDMT alone (n=312). Baseline PASP estimated from echocardiography was categorized as substantially increased (ie, ≥50 mm Hg) or not substantially increased (ie, <50 mm Hg).
Baseline PASP values could be assessed in the echocardiographic core laboratory in 528 (86.0%) patients. A total of 184 patients (n=82 receiving TMVr; n= 102 receiving GDMT) had PASP ≥50 mm Hg (mean, 59.1±8.8 mm Hg), and 344 patients (n=171 receiving TMVr; n=173 receiving GDMT) had PASP <50 mm Hg (mean, 36.3±8.1 mm Hg). Patients with PASP ≥50 mm Hg vs <50 mm Hg had higher 2-year rates of death or heart failure hospitalization (68.8% vs 49.1%, respectively; adjusted hazard ratio, 1.52; 95% CI, 1.17-1.97; P =.002).
The rates of death or heart failure hospitalization were reduced in patients receiving TMVr plus GDMT compared with GDMT alone, regardless of baseline PASP (Pinteraction =.45). In addition, TMVr reduced PASP from baseline to 30 days to a greater degree compared with GDMT alone (adjusted least squares mean, –4.0 mm Hg vs –0.9 mm Hg, respectively; P =.006). This reduction was associated with a lower risk for death or heart failure hospitalization between 30 days and 2 years (adjusted hazard ratio, 0.91 per 5 mm Hg reduction in PASP; 95% CI, 0.86-0.96; P =.0009).
Study limitations include the fact that PASP was not measured by right heart catheterization, which is the gold standard. In addition, because of limitations associated with the use of echocardiography to measure PASP, 14% of participants had missing baseline PASP values and were excluded from the analysis.
“Patients with heart failure with moderate to severe or severe secondary mitral regurgitation had a progressively worse prognosis with increasing PASP,” noted the investigators. “TMVr with the MitraClip reduced PASP to a greater degree than GDMT alone. An early reduction in PASP was a strong independent predictor of improved long-term clinical outcomes. Finally, TMVr resulted in reduced 2-year rates of death and heart failure hospitalization, regardless of baseline PASP.”
Disclosures: The COAPT trial was funded by Abbott. Some of the authors reported affiliations with pharmaceutical and medical device companies. Please see the original reference for a full list of disclosures.
Ben-Yehuda O, Shahim B, Chen S, et al. Pulmonary hypertension in transcatheter mitral valve repair for secondary mitral regurgitation: The COAPT trial. J Am Coll Cardiol. 2020;76(22):2595-2606.