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Transcatheter Mitral Valve Replacement Versus Medical Therapy for Secondary Mitral Regurgitation: A Propensity Score-Matched Comparison

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Transcatheter Mitral Valve Replacement Versus Medical Therapy for Secondary Mitral Regurgitation: A Propensity Score-Matched Comparison. / Ludwig, Sebastian; Conradi, Lenard; Cohen, David J; Coisne, Augustin; Scotti, Andrea; Abraham, William T; Ben Ali, Walid; Zhou, Zhipeng; Li, Yanru; Kar, Saibal; Duncan, Alison; Lim, D Scott; Adamo, Marianna; Redfors, Björn; Muller, David W M; Webb, John G; Petronio, Anna S; Ruge, Hendrik; Nickenig, Georg; Sondergaard, Lars; Adam, Matti; Regazzoli, Damiano; Garatti, Andrea; Schmidt, Tobias; Andreas, Martin; Dahle, Gry; Walther, Thomas; Kempfert, Joerg; Tang, Gilbert H L; Redwood, Simon; Taramasso, Maurizio; Praz, Fabien; Fam, Neil; Dumonteil, Nicolas; Obadia, Jean-François; von Bardeleben, Ralph Stephan; Rudolph, Tanja K; Reardon, Michael J; Metra, Marco; Denti, Paolo; Mack, Michael J; Hausleiter, Jörg; Asch, Federico M; Latib, Azeem; Lindenfeld, JoAnn; Modine, Thomas; Stone, Gregg W; Granada, Juan F; CHOICE-MI and the COAPT Trial Investigators.

In: CIRC-CARDIOVASC INTE, Vol. 16, No. 6, 06.2023, p. e013045.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Ludwig, S, Conradi, L, Cohen, DJ, Coisne, A, Scotti, A, Abraham, WT, Ben Ali, W, Zhou, Z, Li, Y, Kar, S, Duncan, A, Lim, DS, Adamo, M, Redfors, B, Muller, DWM, Webb, JG, Petronio, AS, Ruge, H, Nickenig, G, Sondergaard, L, Adam, M, Regazzoli, D, Garatti, A, Schmidt, T, Andreas, M, Dahle, G, Walther, T, Kempfert, J, Tang, GHL, Redwood, S, Taramasso, M, Praz, F, Fam, N, Dumonteil, N, Obadia, J-F, von Bardeleben, RS, Rudolph, TK, Reardon, MJ, Metra, M, Denti, P, Mack, MJ, Hausleiter, J, Asch, FM, Latib, A, Lindenfeld, J, Modine, T, Stone, GW, Granada, JF & CHOICE-MI and the COAPT Trial Investigators 2023, 'Transcatheter Mitral Valve Replacement Versus Medical Therapy for Secondary Mitral Regurgitation: A Propensity Score-Matched Comparison', CIRC-CARDIOVASC INTE, vol. 16, no. 6, pp. e013045. https://doi.org/10.1161/CIRCINTERVENTIONS.123.013045

APA

Ludwig, S., Conradi, L., Cohen, D. J., Coisne, A., Scotti, A., Abraham, W. T., Ben Ali, W., Zhou, Z., Li, Y., Kar, S., Duncan, A., Lim, D. S., Adamo, M., Redfors, B., Muller, D. W. M., Webb, J. G., Petronio, A. S., Ruge, H., Nickenig, G., ... CHOICE-MI and the COAPT Trial Investigators (2023). Transcatheter Mitral Valve Replacement Versus Medical Therapy for Secondary Mitral Regurgitation: A Propensity Score-Matched Comparison. CIRC-CARDIOVASC INTE, 16(6), e013045. https://doi.org/10.1161/CIRCINTERVENTIONS.123.013045

Vancouver

Ludwig S, Conradi L, Cohen DJ, Coisne A, Scotti A, Abraham WT et al. Transcatheter Mitral Valve Replacement Versus Medical Therapy for Secondary Mitral Regurgitation: A Propensity Score-Matched Comparison. CIRC-CARDIOVASC INTE. 2023 Jun;16(6):e013045. https://doi.org/10.1161/CIRCINTERVENTIONS.123.013045

Bibtex

@article{64786ac3acdb40a4b9bc893afc5e649f,
title = "Transcatheter Mitral Valve Replacement Versus Medical Therapy for Secondary Mitral Regurgitation: A Propensity Score-Matched Comparison",
abstract = "BACKGROUND: Transcatheter mitral valve replacement (TMVR) is an emerging therapeutic alternative for patients with secondary mitral regurgitation (MR). Outcomes of TMVR versus guideline-directed medical therapy (GDMT) have not been investigated for this population. This study aimed to compare clinical outcomes of patients with secondary MR undergoing TMVR versus GDMT alone.METHODS: The CHOICE-MI registry (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency) included patients with MR undergoing TMVR using dedicated devices. Patients with MR pathogeneses other than secondary MR were excluded. Patients treated with GDMT alone were derived from the control arm of the COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation). We compared outcomes between the TMVR and GDMT groups, using propensity score matching to adjust for baseline differences.RESULTS: After propensity score matching, 97 patient pairs undergoing TMVR (72.9±8.7 years; 60.8% men; transapical access, 91.8%) versus GDMT (73.1±11.0 years; 59.8% men) were compared. At 1 and 2 years, residual MR was ≤1+ in all patients of the TMVR group compared with 6.9% and 7.7%, respectively, in those receiving GDMT alone (both P<0.001). The 2-year rate of heart failure hospitalization was significantly lower in the TMVR group (32.8% versus 54.4%; hazard ratio, 0.59 [95% CI, 0.35-0.99]; P=0.04). Among survivors, a higher proportion of patients were in the New York Heart Association functional class I or II in the TMVR group at 1 year (78.2% versus 59.7%; P=0.03) and at 2 years (77.8% versus 53.2%; P=0.09). Two-year mortality was similar in the 2 groups (TMVR versus GDMT, 36.8% versus 40.8%; hazard ratio, 1.01 [95% CI, 0.62-1.64]; P=0.98).CONCLUSIONS: In this observational comparison, over 2-year follow-up, TMVR using mostly transapical devices in patients with secondary MR was associated with significant reduction of MR, symptomatic improvement, less frequent hospitalizations for heart failure, and similar mortality compared with GDMT.REGISTRATION: URL: https://clinicaltrials.gov; Unique identifier: NCT04688190 (CHOICE-MI) and NCT01626079 (COAPT).",
keywords = "Female, Humans, Male, Cardiac Catheterization/adverse effects, Heart Failure/etiology, Heart Valve Prosthesis Implantation, Mitral Valve/diagnostic imaging, Mitral Valve Insufficiency/diagnostic imaging, Propensity Score, Treatment Outcome",
author = "Sebastian Ludwig and Lenard Conradi and Cohen, {David J} and Augustin Coisne and Andrea Scotti and Abraham, {William T} and {Ben Ali}, Walid and Zhipeng Zhou and Yanru Li and Saibal Kar and Alison Duncan and Lim, {D Scott} and Marianna Adamo and Bj{\"o}rn Redfors and Muller, {David W M} and Webb, {John G} and Petronio, {Anna S} and Hendrik Ruge and Georg Nickenig and Lars Sondergaard and Matti Adam and Damiano Regazzoli and Andrea Garatti and Tobias Schmidt and Martin Andreas and Gry Dahle and Thomas Walther and Joerg Kempfert and Tang, {Gilbert H L} and Simon Redwood and Maurizio Taramasso and Fabien Praz and Neil Fam and Nicolas Dumonteil and Jean-Fran{\c c}ois Obadia and {von Bardeleben}, {Ralph Stephan} and Rudolph, {Tanja K} and Reardon, {Michael J} and Marco Metra and Paolo Denti and Mack, {Michael J} and J{\"o}rg Hausleiter and Asch, {Federico M} and Azeem Latib and JoAnn Lindenfeld and Thomas Modine and Stone, {Gregg W} and Granada, {Juan F} and {CHOICE-MI and the COAPT Trial Investigators}",
year = "2023",
month = jun,
doi = "10.1161/CIRCINTERVENTIONS.123.013045",
language = "English",
volume = "16",
pages = "e013045",
journal = "CIRC-CARDIOVASC INTE",
issn = "1941-7640",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

RIS

TY - JOUR

T1 - Transcatheter Mitral Valve Replacement Versus Medical Therapy for Secondary Mitral Regurgitation: A Propensity Score-Matched Comparison

AU - Ludwig, Sebastian

AU - Conradi, Lenard

AU - Cohen, David J

AU - Coisne, Augustin

AU - Scotti, Andrea

AU - Abraham, William T

AU - Ben Ali, Walid

AU - Zhou, Zhipeng

AU - Li, Yanru

AU - Kar, Saibal

AU - Duncan, Alison

AU - Lim, D Scott

AU - Adamo, Marianna

AU - Redfors, Björn

AU - Muller, David W M

AU - Webb, John G

AU - Petronio, Anna S

AU - Ruge, Hendrik

AU - Nickenig, Georg

AU - Sondergaard, Lars

AU - Adam, Matti

AU - Regazzoli, Damiano

AU - Garatti, Andrea

AU - Schmidt, Tobias

AU - Andreas, Martin

AU - Dahle, Gry

AU - Walther, Thomas

AU - Kempfert, Joerg

AU - Tang, Gilbert H L

AU - Redwood, Simon

AU - Taramasso, Maurizio

AU - Praz, Fabien

AU - Fam, Neil

AU - Dumonteil, Nicolas

AU - Obadia, Jean-François

AU - von Bardeleben, Ralph Stephan

AU - Rudolph, Tanja K

AU - Reardon, Michael J

AU - Metra, Marco

AU - Denti, Paolo

AU - Mack, Michael J

AU - Hausleiter, Jörg

AU - Asch, Federico M

AU - Latib, Azeem

AU - Lindenfeld, JoAnn

AU - Modine, Thomas

AU - Stone, Gregg W

AU - Granada, Juan F

AU - CHOICE-MI and the COAPT Trial Investigators

PY - 2023/6

Y1 - 2023/6

N2 - BACKGROUND: Transcatheter mitral valve replacement (TMVR) is an emerging therapeutic alternative for patients with secondary mitral regurgitation (MR). Outcomes of TMVR versus guideline-directed medical therapy (GDMT) have not been investigated for this population. This study aimed to compare clinical outcomes of patients with secondary MR undergoing TMVR versus GDMT alone.METHODS: The CHOICE-MI registry (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency) included patients with MR undergoing TMVR using dedicated devices. Patients with MR pathogeneses other than secondary MR were excluded. Patients treated with GDMT alone were derived from the control arm of the COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation). We compared outcomes between the TMVR and GDMT groups, using propensity score matching to adjust for baseline differences.RESULTS: After propensity score matching, 97 patient pairs undergoing TMVR (72.9±8.7 years; 60.8% men; transapical access, 91.8%) versus GDMT (73.1±11.0 years; 59.8% men) were compared. At 1 and 2 years, residual MR was ≤1+ in all patients of the TMVR group compared with 6.9% and 7.7%, respectively, in those receiving GDMT alone (both P<0.001). The 2-year rate of heart failure hospitalization was significantly lower in the TMVR group (32.8% versus 54.4%; hazard ratio, 0.59 [95% CI, 0.35-0.99]; P=0.04). Among survivors, a higher proportion of patients were in the New York Heart Association functional class I or II in the TMVR group at 1 year (78.2% versus 59.7%; P=0.03) and at 2 years (77.8% versus 53.2%; P=0.09). Two-year mortality was similar in the 2 groups (TMVR versus GDMT, 36.8% versus 40.8%; hazard ratio, 1.01 [95% CI, 0.62-1.64]; P=0.98).CONCLUSIONS: In this observational comparison, over 2-year follow-up, TMVR using mostly transapical devices in patients with secondary MR was associated with significant reduction of MR, symptomatic improvement, less frequent hospitalizations for heart failure, and similar mortality compared with GDMT.REGISTRATION: URL: https://clinicaltrials.gov; Unique identifier: NCT04688190 (CHOICE-MI) and NCT01626079 (COAPT).

AB - BACKGROUND: Transcatheter mitral valve replacement (TMVR) is an emerging therapeutic alternative for patients with secondary mitral regurgitation (MR). Outcomes of TMVR versus guideline-directed medical therapy (GDMT) have not been investigated for this population. This study aimed to compare clinical outcomes of patients with secondary MR undergoing TMVR versus GDMT alone.METHODS: The CHOICE-MI registry (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency) included patients with MR undergoing TMVR using dedicated devices. Patients with MR pathogeneses other than secondary MR were excluded. Patients treated with GDMT alone were derived from the control arm of the COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation). We compared outcomes between the TMVR and GDMT groups, using propensity score matching to adjust for baseline differences.RESULTS: After propensity score matching, 97 patient pairs undergoing TMVR (72.9±8.7 years; 60.8% men; transapical access, 91.8%) versus GDMT (73.1±11.0 years; 59.8% men) were compared. At 1 and 2 years, residual MR was ≤1+ in all patients of the TMVR group compared with 6.9% and 7.7%, respectively, in those receiving GDMT alone (both P<0.001). The 2-year rate of heart failure hospitalization was significantly lower in the TMVR group (32.8% versus 54.4%; hazard ratio, 0.59 [95% CI, 0.35-0.99]; P=0.04). Among survivors, a higher proportion of patients were in the New York Heart Association functional class I or II in the TMVR group at 1 year (78.2% versus 59.7%; P=0.03) and at 2 years (77.8% versus 53.2%; P=0.09). Two-year mortality was similar in the 2 groups (TMVR versus GDMT, 36.8% versus 40.8%; hazard ratio, 1.01 [95% CI, 0.62-1.64]; P=0.98).CONCLUSIONS: In this observational comparison, over 2-year follow-up, TMVR using mostly transapical devices in patients with secondary MR was associated with significant reduction of MR, symptomatic improvement, less frequent hospitalizations for heart failure, and similar mortality compared with GDMT.REGISTRATION: URL: https://clinicaltrials.gov; Unique identifier: NCT04688190 (CHOICE-MI) and NCT01626079 (COAPT).

KW - Female

KW - Humans

KW - Male

KW - Cardiac Catheterization/adverse effects

KW - Heart Failure/etiology

KW - Heart Valve Prosthesis Implantation

KW - Mitral Valve/diagnostic imaging

KW - Mitral Valve Insufficiency/diagnostic imaging

KW - Propensity Score

KW - Treatment Outcome

U2 - 10.1161/CIRCINTERVENTIONS.123.013045

DO - 10.1161/CIRCINTERVENTIONS.123.013045

M3 - SCORING: Journal article

C2 - 37194288

VL - 16

SP - e013045

JO - CIRC-CARDIOVASC INTE

JF - CIRC-CARDIOVASC INTE

SN - 1941-7640

IS - 6

ER -