Patients with heart failure (HF) and severe secondary mitral regurgitation (MR) frequently also suffer from baseline renal disease (RD). Renal function is further impaired by HF and MR, often accelerating progression to end-stage renal disease (ESRD), necessitating a form of renal replacement therapy (RRT). For patients with MR deemed too high-risk for surgery, the transcatheter mitral valve repair procedure MitraClipTM (Abbott, California, USA) has been shown to offer an alternative form of management of MR. Investigators wanted to see if renal outcomes could be impacted by the use of this approach to MR management.
The COAPT trial (NCT01626079) randomized 614 patients with HF and severe MR to receive either the MitraClip plus guideline-directed medical care (GDMT) or GDMT alone. Baseline estimated glomerular filtration rate (eGFR) data was available for 606 of 614 patients; of these, 467 (77.1%) had baseline renal disease, while 139 (22.9%) did not. Investigators further stratified renal disease was further stratified into severe (n=144 [23.8%]) or moderate (n=323 [53.3%] subgroups. The primary endpoint was the 2-year rate of all-cause death or hospitalization for HF (HFH), new onset ESRD, and RRT.
Patients who had worse baseline RD experienced higher rates of mortality or HFH. However, patients who received the MitraClipexperienced lower rates of mortality or HFH than those who had received GDMT alone, regardless of level of severity of baseline RD. Furthermore, patients who received the MitraClipexperienced a 66% decreased incidence of new onset ESRD compared to GDMT. Similarly, the need for new RRT was decreased by 67% in patients receiving MitraClipas compared with those receiving GDMT alone.
Baseline RD should be considered to be a negative prognostic factor in patients with HF and severe MR. The MitraClip seems to have a renal protective effect, lowering rates of both new-onset ESRD and the need for RRT, regardless of severity of RD at baseline.
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Author: Kelly Schoonderwoerd
Original article: Beohar N et al., Eur Heart J 2022;43:1639-1648.