Key result
M-TEER reduced MR severity and the risk of death or heart failure hospitalization compared with GDMT alone regardless of baseline anteroposterior mitral annular diameter (p interaction = 0.87).
Why the study?
Given that increasing APMAD was an independent predictor of death or HFH in COAPT, investigators sought to examine the association of baseline APMAD with long-term clinical outcomes.
Does M-TEER reduce the composite of death or heart failure hospitalizations compared to GDMT alone regardless of baseline anteroposterior mitral annular diameter in patients with severe secondary mitral regurgitation?
RCT (n=575)
randomized
Does M-TEER reduce the composite of death or heart failure hospitalizations compared to GDMT alone regardless of baseline anteroposterior mitral annular diameter in patients with severe secondary mitral regurgitation?
p-value: p=0.87 for interaction
M-TEER reduces MR severity and the risk of death or heart failure hospitalization regardless of baseline anteroposterior mitral annular diameter compared with GDMT alone in patients with severe secondary mitral regurgitation.
APMAD assessment should inform M-TEER selection in severe secondary MR; extends COAPT data into guideline-directed practice.
Background 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. Methods 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. Results 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 ( p interaction = 0.87). Conclusions 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.
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Rogers et al. (2025) conducted an RCT in severe secondary mitral regurgitation (n=575). Mitral transcatheter edge-to-edge repair (M-TEER) vs. Guideline-directed medical therapy (GDMT) alone was evaluated on Composite endpoint of death or heart failure hospitalizations (HFH) (p=0.87 for interaction). M-TEER reduced MR severity and the risk of death or heart failure hospitalization compared with GDMT alone regardless of baseline anteroposterior mitral annular diameter (p interaction = 0.87).
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