Valve repair helps in HF, severe mitral regurgitation, even in patients with malnutrition
Click Here to Manage Email Alerts
Key takeaways:
- Transcatheter mitral valve repair benefited patients with HF and severe mitral regurgitation even if they had malnutrition.
- Malnutrition should not be an exclusion criterion for TEER in this population.
In patients with HF and severe secondary mitral regurgitation, transcatheter edge-to-edge mitral valve repair reduced mortality and HF hospitalization regardless of whether patients had malnutrition, new data from the COAPT trial show.
Andrea Scotti, MD, a structural heart intervention fellow at Montefiore Medical Center, presented an analysis of patients from COAPT stratified by malnutrition at TVT: The Structural Heart Summit. The findings were simultaneously published in the Journal of the American College of Cardiology.
Image: Adobe Stock
For the present analysis of 552 patients from COAPT, the 17% with malnutrition, defined as a Geriatric Nutritional Risk Index score of 98 or lower, were compared with the remainder without malnutrition. Patients were randomly assigned to medical therapy alone or medical therapy plus transcatheter edge-to-edge repair (TEER; MitraClip, Abbott).
“Although malnutrition identifies patients with HF at higher risk of adverse events, the impact of baseline nutritional status on TEER outcomes has not been described,” Scotti and colleagues wrote in JACC.
At 4 years, all-cause mortality was higher in those with malnutrition compared with those without it (68.3% vs. 52.8%; P = .001), according to the researchers.
In multivariate analyses, at 4 years, malnutrition at baseline was associated with elevated risk for all-cause mortality (adjusted HR = 1.37; 95% CI, 1.03-1.82; P = .03) compared with no malnutrition, whereas assignment to TEER plus guideline-directed medical therapy was associated with reduced risk for all-cause mortality (aHR = 0.65; 95% CI, 0.51-0.82; P = .0003) compared with assignment to guideline-directed medical therapy alone, the researchers found.
Malnutrition at baseline did not impact risk for HF hospitalization at 4 years, but assignment to the TEER group reduced it (aHR = 0.46; 95% CI, 0.36-0.56), Scotti and colleagues found.
The treatment effect of TEER did not differ between those with and without malnutrition (adjusted P for interaction for 4-year mortality = .46; adjusted P for interaction for 4-year HF hospitalization = .67), according to the researchers.
“TEER with the percutaneous edge-to-edge mitral valve repair system improved survival and freedom from HF hospitalization independent of baseline malnutrition status,” Scotti and colleagues wrote in JACC. “As such, malnutrition should not be considered a reason to exclude HF patients with severe secondary mitral regurgitation from the potential benefits of TEER, and TEER should be performed in appropriate patients meeting COAPT criteria as early as possible before severe malnutrition and cardiac cachexia develop.”
Reference:
Collapse
Scotti A, et al. Emerging Clinical Science: Mitral III – Mitral TEER. Presented at: TVT: The Structural Heart Summit; June 7-10, 2023; Phoenix.
Click Here to Manage Email Alerts