Regurgitant volume to LA volume ratio in patients with secondary MR: the COAPT trial

Augustin Coisne; Andrea Scotti; Juan F. Granada; Paul A. Grayburn; Michael J. Mack; David J. Cohen; Saibal Kar; D. Scott Lim; Jo Ann Lindenfeld; Jeroen Bax; Lak N. Kotinkaduwa; Björn Redfors; Neil J. Weissman; Federico M. Asch; Gregg W. Stone

doi:10.1093/ehjci/jead328

Regurgitant volume to LA volume ratio in patients with secondary MR: the COAPT trial

Augustin Coisne
, Andrea Scotti
, Juan F. Granada
, Paul A. Grayburn
, Michael J. Mack
, David J. Cohen
, Saibal Kar
, D. Scott Lim
, Jo Ann Lindenfeld
, Jeroen Bax
, Lak N. Kotinkaduwa
, Björn Redfors
, Neil J. Weissman
, Federico M. Asch
, Gregg W. Stone

Medicine

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Aims The conceptual framework of proportionate vs. disproportionate mitral regurgitation (MR) translates poorly to individual patients with heart failure (HF) and secondary MR. A novel index, the ratio of MR severity to left atrial volume (LAV), may identify patients with ‘disproportionate’ MR and a higher risk of events. The objectives, therefore, were to investigate the prognostic impact of MR severity to LAV ratio on outcomes among HF patients with severe secondary MR randomized to transcatheter edge-to-edge repair (TEER) with the MitraClip™ device plus guideline-directed medical therapy (GDMT) vs. GDMT alone in the COAPT trial Methods The ratio of pre-procedural regurgitant volume (RVol) to LAV was calculated from baseline transthoracic echocardiograms. and results The primary endpoint was 2-year covariate-adjusted rate of HF hospitalization (HFH). Among 567 patients, the median RVol/LAV was 0.67 (interquartile range 0.48–0.91). In patients randomized to GDMT alone, lower RVol/LAV was independently associated with an increased 2-year risk of HFH (adjHR: 1.77; 95% CI: 1.20–2.63). RVol/LAV was a stronger predictor of adverse outcomes than RVol or LAV alone. Treatment with TEER plus GDMT compared with GDMT alone was associated with lower 2-year rates of HFH both in patients with low and high RVol/LAV (P_interaction = 0.28). Baseline RVol/LAV ratio was unrelated to 2-year mortality, health status, or functional capacity in either treatment group Conclusion Low RVol/LAV ratio was an independent predictor of 2-year HFH in HF patients with severe MR treated with GDMT alone in the COAPT trial. TEER improved outcomes regardless of baseline RVol/LAV ratio. Clinical Trial Trial Name: Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Registration Functional Mitral Regurgitation (The COAPT Trial) (COAPT) ClinicalTrial.gov Identifier NCT01626079 URL https://clinicaltrials.gov/ct2/show/NCT01626079

Original language	English (US)
Pages (from-to)	616-625
Number of pages	10
Journal	European Heart Journal Cardiovascular Imaging
Volume	25
Issue number	5
DOIs	https://doi.org/10.1093/ehjci/jead328
State	Published - May 1 2024

Keywords

COAPT
left atrial volume
mitral regurgitation
regurgitant volume
transcatheter edge-to-edge repair

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

Access to Document

10.1093/ehjci/jead328

Cite this

Coisne, A., Scotti, A., Granada, J. F., Grayburn, P. A., Mack, M. J., Cohen, D. J., Kar, S., Lim, D. S., Lindenfeld, J. A., Bax, J., Kotinkaduwa, L. N., Redfors, B., Weissman, N. J., Asch, F. M., & Stone, G. W. (2024). Regurgitant volume to LA volume ratio in patients with secondary MR: the COAPT trial. European Heart Journal Cardiovascular Imaging, 25(5), 616-625. https://doi.org/10.1093/ehjci/jead328

Coisne, A, Scotti, A, Granada, JF, Grayburn, PA, Mack, MJ, Cohen, DJ, Kar, S, Lim, DS, Lindenfeld, JA, Bax, J, Kotinkaduwa, LN, Redfors, B, Weissman, NJ, Asch, FM & Stone, GW 2024, 'Regurgitant volume to LA volume ratio in patients with secondary MR: the COAPT trial', European Heart Journal Cardiovascular Imaging, vol. 25, no. 5, pp. 616-625. https://doi.org/10.1093/ehjci/jead328

@article{293c0c99e4a349788d32a5125748ec43,

title = "Regurgitant volume to LA volume ratio in patients with secondary MR: the COAPT trial",

abstract = "Aims The conceptual framework of proportionate vs. disproportionate mitral regurgitation (MR) translates poorly to individual patients with heart failure (HF) and secondary MR. A novel index, the ratio of MR severity to left atrial volume (LAV), may identify patients with {\textquoteleft}disproportionate{\textquoteright} MR and a higher risk of events. The objectives, therefore, were to investigate the prognostic impact of MR severity to LAV ratio on outcomes among HF patients with severe secondary MR randomized to transcatheter edge-to-edge repair (TEER) with the MitraClip{\texttrademark} device plus guideline-directed medical therapy (GDMT) vs. GDMT alone in the COAPT trial Methods The ratio of pre-procedural regurgitant volume (RVol) to LAV was calculated from baseline transthoracic echocardiograms. and results The primary endpoint was 2-year covariate-adjusted rate of HF hospitalization (HFH). Among 567 patients, the median RVol/LAV was 0.67 (interquartile range 0.48{\textendash}0.91). In patients randomized to GDMT alone, lower RVol/LAV was independently associated with an increased 2-year risk of HFH (adjHR: 1.77; 95\% CI: 1.20{\textendash}2.63). RVol/LAV was a stronger predictor of adverse outcomes than RVol or LAV alone. Treatment with TEER plus GDMT compared with GDMT alone was associated with lower 2-year rates of HFH both in patients with low and high RVol/LAV (Pinteraction = 0.28). Baseline RVol/LAV ratio was unrelated to 2-year mortality, health status, or functional capacity in either treatment group Conclusion Low RVol/LAV ratio was an independent predictor of 2-year HFH in HF patients with severe MR treated with GDMT alone in the COAPT trial. TEER improved outcomes regardless of baseline RVol/LAV ratio. Clinical Trial Trial Name: Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Registration Functional Mitral Regurgitation (The COAPT Trial) (COAPT) ClinicalTrial.gov Identifier NCT01626079 URL https://clinicaltrials.gov/ct2/show/NCT01626079",

keywords = "COAPT, left atrial volume, mitral regurgitation, regurgitant volume, transcatheter edge-to-edge repair",

author = "Augustin Coisne and Andrea Scotti and Granada, \{Juan F.\} and Grayburn, \{Paul A.\} and Mack, \{Michael J.\} and Cohen, \{David J.\} and Saibal Kar and Lim, \{D. Scott\} and Lindenfeld, \{Jo Ann\} and Jeroen Bax and Kotinkaduwa, \{Lak N.\} and Bj{\"o}rn Redfors and Weissman, \{Neil J.\} and Asch, \{Federico M.\} and Stone, \{Gregg W.\}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2023. Published by Oxford University Press.",

year = "2024",

month = may,

day = "1",

doi = "10.1093/ehjci/jead328",

language = "English (US)",

volume = "25",

pages = "616--625",

journal = "European Heart Journal Cardiovascular Imaging",

issn = "2047-2404",

publisher = "Oxford University Press",

number = "5",

}

TY - JOUR

T1 - Regurgitant volume to LA volume ratio in patients with secondary MR

T2 - the COAPT trial

AU - Coisne, Augustin

AU - Scotti, Andrea

AU - Granada, Juan F.

AU - Grayburn, Paul A.

AU - Mack, Michael J.

AU - Cohen, David J.

AU - Kar, Saibal

AU - Lim, D. Scott

AU - Lindenfeld, Jo Ann

AU - Bax, Jeroen

AU - Kotinkaduwa, Lak N.

AU - Redfors, Björn

AU - Weissman, Neil J.

AU - Asch, Federico M.

AU - Stone, Gregg W.

PY - 2024/5/1

Y1 - 2024/5/1

N2 - Aims The conceptual framework of proportionate vs. disproportionate mitral regurgitation (MR) translates poorly to individual patients with heart failure (HF) and secondary MR. A novel index, the ratio of MR severity to left atrial volume (LAV), may identify patients with ‘disproportionate’ MR and a higher risk of events. The objectives, therefore, were to investigate the prognostic impact of MR severity to LAV ratio on outcomes among HF patients with severe secondary MR randomized to transcatheter edge-to-edge repair (TEER) with the MitraClip™ device plus guideline-directed medical therapy (GDMT) vs. GDMT alone in the COAPT trial Methods The ratio of pre-procedural regurgitant volume (RVol) to LAV was calculated from baseline transthoracic echocardiograms. and results The primary endpoint was 2-year covariate-adjusted rate of HF hospitalization (HFH). Among 567 patients, the median RVol/LAV was 0.67 (interquartile range 0.48–0.91). In patients randomized to GDMT alone, lower RVol/LAV was independently associated with an increased 2-year risk of HFH (adjHR: 1.77; 95% CI: 1.20–2.63). RVol/LAV was a stronger predictor of adverse outcomes than RVol or LAV alone. Treatment with TEER plus GDMT compared with GDMT alone was associated with lower 2-year rates of HFH both in patients with low and high RVol/LAV (Pinteraction = 0.28). Baseline RVol/LAV ratio was unrelated to 2-year mortality, health status, or functional capacity in either treatment group Conclusion Low RVol/LAV ratio was an independent predictor of 2-year HFH in HF patients with severe MR treated with GDMT alone in the COAPT trial. TEER improved outcomes regardless of baseline RVol/LAV ratio. Clinical Trial Trial Name: Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Registration Functional Mitral Regurgitation (The COAPT Trial) (COAPT) ClinicalTrial.gov Identifier NCT01626079 URL https://clinicaltrials.gov/ct2/show/NCT01626079

AB - Aims The conceptual framework of proportionate vs. disproportionate mitral regurgitation (MR) translates poorly to individual patients with heart failure (HF) and secondary MR. A novel index, the ratio of MR severity to left atrial volume (LAV), may identify patients with ‘disproportionate’ MR and a higher risk of events. The objectives, therefore, were to investigate the prognostic impact of MR severity to LAV ratio on outcomes among HF patients with severe secondary MR randomized to transcatheter edge-to-edge repair (TEER) with the MitraClip™ device plus guideline-directed medical therapy (GDMT) vs. GDMT alone in the COAPT trial Methods The ratio of pre-procedural regurgitant volume (RVol) to LAV was calculated from baseline transthoracic echocardiograms. and results The primary endpoint was 2-year covariate-adjusted rate of HF hospitalization (HFH). Among 567 patients, the median RVol/LAV was 0.67 (interquartile range 0.48–0.91). In patients randomized to GDMT alone, lower RVol/LAV was independently associated with an increased 2-year risk of HFH (adjHR: 1.77; 95% CI: 1.20–2.63). RVol/LAV was a stronger predictor of adverse outcomes than RVol or LAV alone. Treatment with TEER plus GDMT compared with GDMT alone was associated with lower 2-year rates of HFH both in patients with low and high RVol/LAV (Pinteraction = 0.28). Baseline RVol/LAV ratio was unrelated to 2-year mortality, health status, or functional capacity in either treatment group Conclusion Low RVol/LAV ratio was an independent predictor of 2-year HFH in HF patients with severe MR treated with GDMT alone in the COAPT trial. TEER improved outcomes regardless of baseline RVol/LAV ratio. Clinical Trial Trial Name: Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Registration Functional Mitral Regurgitation (The COAPT Trial) (COAPT) ClinicalTrial.gov Identifier NCT01626079 URL https://clinicaltrials.gov/ct2/show/NCT01626079

KW - COAPT

KW - left atrial volume

KW - mitral regurgitation

KW - regurgitant volume

KW - transcatheter edge-to-edge repair

UR - https://www.scopus.com/pages/publications/85183545363

UR - https://www.scopus.com/pages/publications/85183545363#tab=citedBy

U2 - 10.1093/ehjci/jead328

DO - 10.1093/ehjci/jead328

M3 - Article

C2 - 38060997

AN - SCOPUS:85183545363

SN - 2047-2404

VL - 25

SP - 616

EP - 625

JO - European Heart Journal Cardiovascular Imaging

JF - European Heart Journal Cardiovascular Imaging

IS - 5

ER -

Regurgitant volume to LA volume ratio in patients with secondary MR: the COAPT trial

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