Impact of Baseline Anteroposterior Mitral Annular Dimensions on Clinical Outcomes after MitraClip for Secondary Mitral Regurgitation

TL;DR

This study shows that a heart procedure called MitraClip improves outcomes for patients with heart failure and leaky heart valves, regardless of the size of a specific heart structure.

Contribution

The study demonstrates that MitraClip effectiveness is consistent across varying sizes of the anteroposterior mitral annular diameter.

Findings

MitraClip reduces mitral regurgitation and the risk of death or heart failure hospitalizations regardless of baseline anteroposterior mitral annular diameter.

Patients treated with MitraClip show improved functional capacity and quality of life at 2 years.

Larger anteroposterior mitral annular diameters predict worse outcomes in patients treated with medical therapy alone.

Abstract

In the randomized Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT; NCT01626079) trial, mitral transcatheter edge-to-edge repair (M-TEER) improved clinical outcomes in patients with severe secondary mitral regurgitation (MR). A prior post hoc analysis from the COAPT trial showed that increasing anteroposterior mitral annular diameter (APMAD) was the sole independent echocardiographic predictor of the composite endpoint of death or heart failure hospitalizations (HFH) at 2 years. Given the relationship between the mitral annulus and leaflets, we examined the association of baseline APMAD with long-term clinical outcomes.

COAPT patients (n = 575) were stratified into tertiles by baseline APMAD as follows: small APMAD, medium APMAD, and large APMAD. APMAD was measured in the anteroposterior direction from the parasternal long-axis view at end-diastole and in the intercommissural direction from the apical two-chamber view.

Patients with larger baseline APMAD were more often male and had fewer comorbidities, larger ventricles, and larger mitral orifice areas. At 2 years, there were no significant differences in MR severity and the composite endpoint of death or HFH in patients treated with M-TEER by baseline APMAD. In patients treated with guideline-directed medical therapy (GDMT) alone, there were no significant differences in MR severity, but the composite endpoint of death or HFH was higher in patients with the largest baseline APMADs. The treatment effect of M-TEER was consistent among APMAD tertiles (pinteraction = 0.87).

APMAD was a predictor of adverse outcomes in patients treated with GDMT alone. M-TEER reduced MR severity and the risk of death or HFH regardless of baseline APMAD compared with GDMT alone.

•Mitral transcatheter edge-to-edge repair (M-TEER) is effective across a range of anteroposterior mitral annular diameters (APMADs).•Mitral regurgitation and death/HFH are reduced by M-TEER regardless of APMAD.•Functional capacity and quality of life are also significantly improved at 2 years.

Mitral transcatheter edge-to-edge repair (M-TEER) is effective across a range of anteroposterior mitral annular diameters (APMADs).

Mitral regurgitation and death/HFH are reduced by M-TEER regardless of APMAD.

Functional capacity and quality of life are also significantly improved at 2 years.

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