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Changes in Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial. | LitMetric

AI Article Synopsis

  • Left ventricular global longitudinal strain (LV GLS) is a useful measurement for predicting outcomes in heart failure patients, especially when considering improvements over traditional measurements like ejection fraction.
  • The COAPT trial studied patients with heart failure and severe mitral regurgitation, comparing the effects of a MitraClip device plus medical therapy against medical therapy alone, focusing on changes in LV GLS after 6 months.
  • Results showed that about 45% of patients had improved LV GLS, which was linked to significantly lower rates of death and heart failure hospitalizations in the following 6 to 24 months for both treatment groups.

Article Abstract

Background Left ventricular (LV) global longitudinal strain (GLS) provides incremental prognostic information over LV ejection fraction in patients with heart failure (HF) and secondary mitral regurgitation. We examined the prognostic impact of LV GLS improvement in this population. Methods and Results The COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial randomized symptomatic patients with HF with severe (3+/4+) mitral regurgitation to transcatheter edge-to-edge repair with the MitraClip device plus maximally tolerated guideline-directed medical therapy (GDMT) versus GDMT alone. LV GLS was measured at baseline and 6-month follow-up. The relationship between the improvement in LV GLS from baseline to 6 months and the composite of all-cause death or HF hospitalization between 6- and 24-month follow-up were assessed. Among 383 patients, 174 (45.4%) had improved LV GLS at 6-month follow-up (83/195 [42.6%] with transcatheter edge-to-edge repair+GDMT and 91/188 [48.4%] with GDMT alone; =0.25). Improvement in LV GLS was strongly associated with reduced death or HF hospitalization between 6 and 24 months (<0.009), with similar risk reduction in both treatment arms (=0.40). By multivariable analysis, LV GLS improvement at 6 months was independently associated with a lower risk of death or HF hospitalization (hazard ratio [HR], 0.55 [95% CI, 0.36-0.83]; =0.009), death (HR, 0.48 [95% CI, 0.29-0.81]; =0.006), and HF hospitalization (HR, 0.50 [95% CI, 0.31-0.81]; =0.005) between 6 and 24 months. Conclusions Among patients with HF and severe mitral regurgitation in the COAPT trial, improvement in LV GLS at 6-month follow-up was associated with improved outcomes after both transcatheter edge-to-edge repair and GDMT alone between 6 and 24 months. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01626079.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10547326PMC
http://dx.doi.org/10.1161/JAHA.122.029956DOI Listing

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