Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography | 2021
Left Ventricular Global Longitudinal Strain as a Predictor of Outcomes in Heart Failure Patients with Secondary Mitral Regurgitation: The COAPT Trial.
Abstract
BACKGROUND\nLeft ventricular (LV) global longitudinal strain (GLS) is a sensitive marker of LV function and may help identify patients with heart failure (HF) and secondary mitral regurgitation (SMR) who would have a better prognosis and are more likely to benefit from edge-to-edge transcatheter mitral valve repair (TMVr) with the MitraClip. We sought to assess the prognostic utility of baseline LVGLS during 2-year follow-up of HF patients with SMR enrolled in the COAPT trial.\n\n\nMETHODS\nSymptomatic HF patients with moderate-to-severe or severe SMR who remained symptomatic despite maximally-tolerated guideline directed medical therapy (GDMT) were randomized to TMVr plus GDMT or GDMT alone. Speckle tracking-derived LVGLS from baseline echocardiograms was obtained in 565 patients and categorized by tertiles. Death and HF hospitalization (HFH) at 2-year follow-up were the principal outcomes of interest.\n\n\nRESULTS\nPatients with better baseline LVGLS had higher blood pressure, greater LV ejection fraction and stroke volume, lower levels of B-type natriuretic peptide and smaller LV size. No significant difference in outcomes at 2-year follow-up were noted according to LVGLS. However, the rate of death or HFH between 10 and 24 months was lower in patients with better LVGLS (p=0.03), with no differences before 10 months. There was no interaction between GLS tertiles and treatment group with respect to 2-year clinical outcomes.\n\n\nCONCLUSIONS\nBaseline LVGLS did not predict death or HFH throughout 2-year follow-up, but it did predict outcomes after 10 months. The benefit of TMVr over GDMT alone was consistent in all sub-groups irrespective of baseline LVGLS.