Forward Flow in Patients With Heart Failure and Functional Mitral Regurgitation: The COAPT Trial

Journal of the Society for Cardiovascular Angiography & Interventions Pub Date : 2025-05-01 DOI:10.1016/j.jscai.2025.102609

Zachary M. Gertz MD, MBE , Philippe Pibarot DVM, PhD , Zhipeng Zhou MA , Michael J. Schonning MS, MBS , Björn Redfors MD, PhD , Yanru Li MS, MPH , Saibal Kar MD , D. Scott Lim MD , Neil J. Weissman MD , David J. Cohen MD, MSc , JoAnn Lindenfeld MD , William T. Abraham MD , Michael J. Mack MD , Federico M. Asch MD , Gregg W. Stone MD

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引用次数: 0

Abstract

Background

Heart failure (HF) is characterized by a reduction in forward cardiac output (forward flow), potentially worsened by functional mitral regurgitation (FMR). The impact of reduced forward flow in HF patients with FMR is uncertain, and the outcomes of mitral transcatheter edge-to-edge repair (TEER) according to forward flow levels have not been described.

Methods

This study assessed the change in baseline flow in patients with HF and FMR enrolled in the COAPT trial randomized to TEER plus guideline-directed medical therapy (GDMT) compared with GDMT alone. Patients were stratified into tertiles of baseline forward flow using the Doppler-derived stroke volume index. The primary outcome was the composite rate of death or HF hospitalization at 24 months. Clinical, echocardiographic, and outcome measures were assessed.

Results

Among patients randomized to GDMT alone, the lowest baseline forward flow tertile was associated with worse outcomes (P = .04). In contrast, baseline forward flow tertile was not associated with outcomes among patients randomized to TEER + GDMT (P = .88). Patients in the lowest tertile treated with TEER + GDMT had the largest absolute reduction in the primary outcome (44.6% vs 75.7%; hazard ratio [HR], 0.43; 95% CI, 0.29-0.63), whereas patients in the highest tertile had the smallest absolute benefit after TEER (42.8% vs 57.9%; HR, 0.69; 95% CI, 0.45-1.04). However, the relative treatment effect was not different between tertiles (p_interaction = 0.32). Mean forward flow did not significantly increase during 2-year follow-up, and was similar between treatment groups at all time periods.

Conclusions

In the COAPT trial, lower baseline forward flow was associated with worse outcomes in medically managed patients, and those with low baseline forward flow derived the greatest absolute benefit from TEER. However, measured forward flow did not improve with TEER during the 2-year follow-up.

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心力衰竭和功能性二尖瓣反流患者的前流：COAPT试验

心衰（HF）的特征是前向心输出量（前向血流）减少，可能因功能性二尖瓣反流（FMR）而恶化。前向血流减少对FMR心衰患者的影响尚不确定，根据前向血流水平进行二尖瓣经导管边缘到边缘修复（TEER）的结果尚未描述。方法本研究评估了COAPT试验中HF和FMR患者基线血流的变化，这些患者被随机分配到TEER +指南导向药物治疗（GDMT）与单独GDMT。使用多普勒衍生的脑卒中容积指数将患者分层为基线前流的三分位数。主要终点是24个月时的死亡率或心衰住院率。评估临床、超声心动图和结局指标。结果：在随机接受GDMT治疗的患者中，最低基线前流胎数与较差的预后相关（P = 0.04）。相比之下，在随机分配到TEER + GDMT的患者中，基线前流式不孕率与结果无关（P = 0.88）。接受TEER + GDMT治疗的最低胎率患者的主要结局绝对降低幅度最大(44.6% vs 75.7%；风险比[HR]， 0.43；95% CI, 0.29-0.63)，而最高水平的患者在TEER后的绝对获益最小(42.8% vs 57.9%；人力资源,0.69;95% ci, 0.45-1.04)。然而，相对处理效果在三组分间无显著差异（p互作= 0.32）。在2年的随访中，平均前流没有显著增加，各治疗组在所有时间段的前流相似。在COAPT试验中，较低的基线前流与较差的医学管理患者预后相关，而基线前流较低的患者从TEER中获得的绝对获益最大。然而，在2年的随访中，TEER并没有改善测量的前流。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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