Impact of baseline renal dysfunction on cardiac outcomes and end-stage renal disease in heart failure patients with mitral regurgitation: the COAPT trial
Abstract Aims Baseline renal dysfunction (RD) adversely impacts outcomes among patients with heart failure (HF) and severe secondary mitral regurgitation (MR). Heart failure and MR, in turn, accelerate progression to end-stage renal disease (ESRD), worsening prognosis. We sought to determine the imp...
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| Veröffentlicht in: | European heart journal 2022-05, Vol.43 (17), p.1639-1648 |
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| creator | Beohar, Nirat Ailawadi, Gorav Kotinkaduwa, Lak N Redfors, Björn Simonato, Matheus Zhang, Zixuan Morgan, Loren Garrison Escolar, Esteban Kar, Saibal Lim, David Scott Mishell, Jacob M Whisenant, Brian K Abraham, William T Lindenfeld, JoAnn Mack, Michael J Stone, Gregg W |
| description | Abstract
Aims
Baseline renal dysfunction (RD) adversely impacts outcomes among patients with heart failure (HF) and severe secondary mitral regurgitation (MR). Heart failure and MR, in turn, accelerate progression to end-stage renal disease (ESRD), worsening prognosis. We sought to determine the impact of RD in HF patients with severe MR and the impact of transcatheter mitral valve repair (TMVr) on new-onset ESRD and the need for renal replacement therapy (RRT).
Methods and results
The COAPT trial randomized 614 patients with HF and severe MR to MitraClip plus guideline-directed medical therapy (GDMT) vs. GDMT alone. Patients were stratified into three RD subgroups based on baseline estimated glomerular filtration rate (eGFR, mL/min/1.73 m2): none (≥60), moderate (30–60), and severe ( |
| doi_str_mv | 10.1093/eurheartj/ehac026 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2627136432</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/eurheartj/ehac026</oup_id><sourcerecordid>2627136432</sourcerecordid><originalsourceid>FETCH-LOGICAL-c338t-6fb77f8621a70f3546ad3e29536e39a15caefb8b35f9479872e39844927730a43</originalsourceid><addsrcrecordid>eNqNkctq3DAUhkVpaSZpH6CbomUXdaOLLVndhaFNA4F0kUJ35lg-mlGwZVcXQh6lb1unM511QXBAfP93DvyEvOPsE2dGXmKJe4SYHy5xD5YJ9YJseCNEZVTdvCQbxk1TKdX-PCPnKT0wxlrF1WtyJhsu69boDfl9My1gM50d7SHh6APSiAFGOjwlV4LNfg50fRbi4MHSuWQ7T5gohIFiGKqUYXfK-ISrhfpA_x5GHfixRKQLZI8hJ_ro855OPseVjrgrceczPO_4TPMe6fbu6vs9zdHD-Ia8cjAmfHucF-TH1y_322_V7d31zfbqtrJStrlSrtfatUpw0MzJplYwSBSmkQqlAd5YQNe3vWycqbVptVi_27o2QmvJoJYX5MPBu8T5V8GUu8kni-MIAeeSOqGE5lLVUqwoP6A2zilFdN0S_QTxqeOse26kOzXSHRtZM--P-tJPOJwS_ypYgY8HYC7Lf_j-ACMznJ0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2627136432</pqid></control><display><type>article</type><title>Impact of baseline renal dysfunction on cardiac outcomes and end-stage renal disease in heart failure patients with mitral regurgitation: the COAPT trial</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Beohar, Nirat ; Ailawadi, Gorav ; Kotinkaduwa, Lak N ; Redfors, Björn ; Simonato, Matheus ; Zhang, Zixuan ; Morgan, Loren Garrison ; Escolar, Esteban ; Kar, Saibal ; Lim, David Scott ; Mishell, Jacob M ; Whisenant, Brian K ; Abraham, William T ; Lindenfeld, JoAnn ; Mack, Michael J ; Stone, Gregg W</creator><creatorcontrib>Beohar, Nirat ; Ailawadi, Gorav ; Kotinkaduwa, Lak N ; Redfors, Björn ; Simonato, Matheus ; Zhang, Zixuan ; Morgan, Loren Garrison ; Escolar, Esteban ; Kar, Saibal ; Lim, David Scott ; Mishell, Jacob M ; Whisenant, Brian K ; Abraham, William T ; Lindenfeld, JoAnn ; Mack, Michael J ; Stone, Gregg W</creatorcontrib><description>Abstract
Aims
Baseline renal dysfunction (RD) adversely impacts outcomes among patients with heart failure (HF) and severe secondary mitral regurgitation (MR). Heart failure and MR, in turn, accelerate progression to end-stage renal disease (ESRD), worsening prognosis. We sought to determine the impact of RD in HF patients with severe MR and the impact of transcatheter mitral valve repair (TMVr) on new-onset ESRD and the need for renal replacement therapy (RRT).
Methods and results
The COAPT trial randomized 614 patients with HF and severe MR to MitraClip plus guideline-directed medical therapy (GDMT) vs. GDMT alone. Patients were stratified into three RD subgroups based on baseline estimated glomerular filtration rate (eGFR, mL/min/1.73 m2): none (≥60), moderate (30–60), and severe (<30). End-stage renal disease was defined as eGFR <15 mL/min/1.73 m2 or RRT. The 2-year rates of all-cause death or HF hospitalization (HFH), new-onset ESRD, and RRT according to RD and treatment were assessed. Baseline RD was present in 77.0% of patients, including 23.8% severe RD, 6.0% ESRD, and 5.2% RRT. Worse RD was associated with greater 2-year risk of death or HFH (none 45.3%; moderate 53.9%; severe 69.2%; P < 0.0001). MitraClip vs. GDMT alone improved outcomes regardless of RD (Pinteraction = 0.62) and reduced new-onset ESRD [2.9 vs. 8.1%, hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.15–0.76, P = 0.008] and the need for new RRT (2.5 vs. 7.4%, HR 0.33, 95% CI 0.14–0.78, P = 0.011).
Conclusion
Baseline RD was common in the HF patients with severe MR enrolled in COAPT and strongly predicted 2-year death and HFH. MitraClip treatment reduced new-onset ESRD and the need for RRT, contributing to the improved prognosis after TMVr.
Structured Graphical Abstract
Structured Graphical Abstract
In the COAPT Trial, baseline renal dysfunction was common and strongly predicted 2-year death and heart failure hospitalization (HFH). However, treatment with the MitraClip was beneficial across all renal function groups in reducing the composite outcome of all-cause death and HFH (left). In addition, MitraClip treatment reduced incident end stage renal disease (top right) and the need for renal replacement therapy (bottom right).</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehac026</identifier><identifier>PMID: 35134897</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Heart Failure - epidemiology ; Heart Valve Prosthesis Implantation - adverse effects ; Humans ; Kidney Failure, Chronic - epidemiology ; Mitral Valve - surgery ; Mitral Valve Insufficiency - complications ; Mitral Valve Insufficiency - surgery ; Treatment Outcome</subject><ispartof>European heart journal, 2022-05, Vol.43 (17), p.1639-1648</ispartof><rights>The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2022</rights><rights>The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c338t-6fb77f8621a70f3546ad3e29536e39a15caefb8b35f9479872e39844927730a43</citedby><cites>FETCH-LOGICAL-c338t-6fb77f8621a70f3546ad3e29536e39a15caefb8b35f9479872e39844927730a43</cites><orcidid>0000-0002-3416-8210 ; 0000-0003-4805-1037 ; 0000-0001-6852-4220 ; 0000-0002-2973-3369 ; 0000-0002-4155-4451</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35134897$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Beohar, Nirat</creatorcontrib><creatorcontrib>Ailawadi, Gorav</creatorcontrib><creatorcontrib>Kotinkaduwa, Lak N</creatorcontrib><creatorcontrib>Redfors, Björn</creatorcontrib><creatorcontrib>Simonato, Matheus</creatorcontrib><creatorcontrib>Zhang, Zixuan</creatorcontrib><creatorcontrib>Morgan, Loren Garrison</creatorcontrib><creatorcontrib>Escolar, Esteban</creatorcontrib><creatorcontrib>Kar, Saibal</creatorcontrib><creatorcontrib>Lim, David Scott</creatorcontrib><creatorcontrib>Mishell, Jacob M</creatorcontrib><creatorcontrib>Whisenant, Brian K</creatorcontrib><creatorcontrib>Abraham, William T</creatorcontrib><creatorcontrib>Lindenfeld, JoAnn</creatorcontrib><creatorcontrib>Mack, Michael J</creatorcontrib><creatorcontrib>Stone, Gregg W</creatorcontrib><title>Impact of baseline renal dysfunction on cardiac outcomes and end-stage renal disease in heart failure patients with mitral regurgitation: the COAPT trial</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>Abstract
Aims
Baseline renal dysfunction (RD) adversely impacts outcomes among patients with heart failure (HF) and severe secondary mitral regurgitation (MR). Heart failure and MR, in turn, accelerate progression to end-stage renal disease (ESRD), worsening prognosis. We sought to determine the impact of RD in HF patients with severe MR and the impact of transcatheter mitral valve repair (TMVr) on new-onset ESRD and the need for renal replacement therapy (RRT).
Methods and results
The COAPT trial randomized 614 patients with HF and severe MR to MitraClip plus guideline-directed medical therapy (GDMT) vs. GDMT alone. Patients were stratified into three RD subgroups based on baseline estimated glomerular filtration rate (eGFR, mL/min/1.73 m2): none (≥60), moderate (30–60), and severe (<30). End-stage renal disease was defined as eGFR <15 mL/min/1.73 m2 or RRT. The 2-year rates of all-cause death or HF hospitalization (HFH), new-onset ESRD, and RRT according to RD and treatment were assessed. Baseline RD was present in 77.0% of patients, including 23.8% severe RD, 6.0% ESRD, and 5.2% RRT. Worse RD was associated with greater 2-year risk of death or HFH (none 45.3%; moderate 53.9%; severe 69.2%; P < 0.0001). MitraClip vs. GDMT alone improved outcomes regardless of RD (Pinteraction = 0.62) and reduced new-onset ESRD [2.9 vs. 8.1%, hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.15–0.76, P = 0.008] and the need for new RRT (2.5 vs. 7.4%, HR 0.33, 95% CI 0.14–0.78, P = 0.011).
Conclusion
Baseline RD was common in the HF patients with severe MR enrolled in COAPT and strongly predicted 2-year death and HFH. MitraClip treatment reduced new-onset ESRD and the need for RRT, contributing to the improved prognosis after TMVr.
Structured Graphical Abstract
Structured Graphical Abstract
In the COAPT Trial, baseline renal dysfunction was common and strongly predicted 2-year death and heart failure hospitalization (HFH). However, treatment with the MitraClip was beneficial across all renal function groups in reducing the composite outcome of all-cause death and HFH (left). In addition, MitraClip treatment reduced incident end stage renal disease (top right) and the need for renal replacement therapy (bottom right).</description><subject>Heart Failure - epidemiology</subject><subject>Heart Valve Prosthesis Implantation - adverse effects</subject><subject>Humans</subject><subject>Kidney Failure, Chronic - epidemiology</subject><subject>Mitral Valve - surgery</subject><subject>Mitral Valve Insufficiency - complications</subject><subject>Mitral Valve Insufficiency - surgery</subject><subject>Treatment Outcome</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkctq3DAUhkVpaSZpH6CbomUXdaOLLVndhaFNA4F0kUJ35lg-mlGwZVcXQh6lb1unM511QXBAfP93DvyEvOPsE2dGXmKJe4SYHy5xD5YJ9YJseCNEZVTdvCQbxk1TKdX-PCPnKT0wxlrF1WtyJhsu69boDfl9My1gM50d7SHh6APSiAFGOjwlV4LNfg50fRbi4MHSuWQ7T5gohIFiGKqUYXfK-ISrhfpA_x5GHfixRKQLZI8hJ_ro855OPseVjrgrceczPO_4TPMe6fbu6vs9zdHD-Ia8cjAmfHucF-TH1y_322_V7d31zfbqtrJStrlSrtfatUpw0MzJplYwSBSmkQqlAd5YQNe3vWycqbVptVi_27o2QmvJoJYX5MPBu8T5V8GUu8kni-MIAeeSOqGE5lLVUqwoP6A2zilFdN0S_QTxqeOse26kOzXSHRtZM--P-tJPOJwS_ypYgY8HYC7Lf_j-ACMznJ0</recordid><startdate>20220501</startdate><enddate>20220501</enddate><creator>Beohar, Nirat</creator><creator>Ailawadi, Gorav</creator><creator>Kotinkaduwa, Lak N</creator><creator>Redfors, Björn</creator><creator>Simonato, Matheus</creator><creator>Zhang, Zixuan</creator><creator>Morgan, Loren Garrison</creator><creator>Escolar, Esteban</creator><creator>Kar, Saibal</creator><creator>Lim, David Scott</creator><creator>Mishell, Jacob M</creator><creator>Whisenant, Brian K</creator><creator>Abraham, William T</creator><creator>Lindenfeld, JoAnn</creator><creator>Mack, Michael J</creator><creator>Stone, Gregg W</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3416-8210</orcidid><orcidid>https://orcid.org/0000-0003-4805-1037</orcidid><orcidid>https://orcid.org/0000-0001-6852-4220</orcidid><orcidid>https://orcid.org/0000-0002-2973-3369</orcidid><orcidid>https://orcid.org/0000-0002-4155-4451</orcidid></search><sort><creationdate>20220501</creationdate><title>Impact of baseline renal dysfunction on cardiac outcomes and end-stage renal disease in heart failure patients with mitral regurgitation: the COAPT trial</title><author>Beohar, Nirat ; Ailawadi, Gorav ; Kotinkaduwa, Lak N ; Redfors, Björn ; Simonato, Matheus ; Zhang, Zixuan ; Morgan, Loren Garrison ; Escolar, Esteban ; Kar, Saibal ; Lim, David Scott ; Mishell, Jacob M ; Whisenant, Brian K ; Abraham, William T ; Lindenfeld, JoAnn ; Mack, Michael J ; Stone, Gregg W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c338t-6fb77f8621a70f3546ad3e29536e39a15caefb8b35f9479872e39844927730a43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Heart Failure - epidemiology</topic><topic>Heart Valve Prosthesis Implantation - adverse effects</topic><topic>Humans</topic><topic>Kidney Failure, Chronic - epidemiology</topic><topic>Mitral Valve - surgery</topic><topic>Mitral Valve Insufficiency - complications</topic><topic>Mitral Valve Insufficiency - surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Beohar, Nirat</creatorcontrib><creatorcontrib>Ailawadi, Gorav</creatorcontrib><creatorcontrib>Kotinkaduwa, Lak N</creatorcontrib><creatorcontrib>Redfors, Björn</creatorcontrib><creatorcontrib>Simonato, Matheus</creatorcontrib><creatorcontrib>Zhang, Zixuan</creatorcontrib><creatorcontrib>Morgan, Loren Garrison</creatorcontrib><creatorcontrib>Escolar, Esteban</creatorcontrib><creatorcontrib>Kar, Saibal</creatorcontrib><creatorcontrib>Lim, David Scott</creatorcontrib><creatorcontrib>Mishell, Jacob M</creatorcontrib><creatorcontrib>Whisenant, Brian K</creatorcontrib><creatorcontrib>Abraham, William T</creatorcontrib><creatorcontrib>Lindenfeld, JoAnn</creatorcontrib><creatorcontrib>Mack, Michael J</creatorcontrib><creatorcontrib>Stone, Gregg W</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Beohar, Nirat</au><au>Ailawadi, Gorav</au><au>Kotinkaduwa, Lak N</au><au>Redfors, Björn</au><au>Simonato, Matheus</au><au>Zhang, Zixuan</au><au>Morgan, Loren Garrison</au><au>Escolar, Esteban</au><au>Kar, Saibal</au><au>Lim, David Scott</au><au>Mishell, Jacob M</au><au>Whisenant, Brian K</au><au>Abraham, William T</au><au>Lindenfeld, JoAnn</au><au>Mack, Michael J</au><au>Stone, Gregg W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of baseline renal dysfunction on cardiac outcomes and end-stage renal disease in heart failure patients with mitral regurgitation: the COAPT trial</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2022-05-01</date><risdate>2022</risdate><volume>43</volume><issue>17</issue><spage>1639</spage><epage>1648</epage><pages>1639-1648</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Abstract
Aims
Baseline renal dysfunction (RD) adversely impacts outcomes among patients with heart failure (HF) and severe secondary mitral regurgitation (MR). Heart failure and MR, in turn, accelerate progression to end-stage renal disease (ESRD), worsening prognosis. We sought to determine the impact of RD in HF patients with severe MR and the impact of transcatheter mitral valve repair (TMVr) on new-onset ESRD and the need for renal replacement therapy (RRT).
Methods and results
The COAPT trial randomized 614 patients with HF and severe MR to MitraClip plus guideline-directed medical therapy (GDMT) vs. GDMT alone. Patients were stratified into three RD subgroups based on baseline estimated glomerular filtration rate (eGFR, mL/min/1.73 m2): none (≥60), moderate (30–60), and severe (<30). End-stage renal disease was defined as eGFR <15 mL/min/1.73 m2 or RRT. The 2-year rates of all-cause death or HF hospitalization (HFH), new-onset ESRD, and RRT according to RD and treatment were assessed. Baseline RD was present in 77.0% of patients, including 23.8% severe RD, 6.0% ESRD, and 5.2% RRT. Worse RD was associated with greater 2-year risk of death or HFH (none 45.3%; moderate 53.9%; severe 69.2%; P < 0.0001). MitraClip vs. GDMT alone improved outcomes regardless of RD (Pinteraction = 0.62) and reduced new-onset ESRD [2.9 vs. 8.1%, hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.15–0.76, P = 0.008] and the need for new RRT (2.5 vs. 7.4%, HR 0.33, 95% CI 0.14–0.78, P = 0.011).
Conclusion
Baseline RD was common in the HF patients with severe MR enrolled in COAPT and strongly predicted 2-year death and HFH. MitraClip treatment reduced new-onset ESRD and the need for RRT, contributing to the improved prognosis after TMVr.
Structured Graphical Abstract
Structured Graphical Abstract
In the COAPT Trial, baseline renal dysfunction was common and strongly predicted 2-year death and heart failure hospitalization (HFH). However, treatment with the MitraClip was beneficial across all renal function groups in reducing the composite outcome of all-cause death and HFH (left). In addition, MitraClip treatment reduced incident end stage renal disease (top right) and the need for renal replacement therapy (bottom right).</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>35134897</pmid><doi>10.1093/eurheartj/ehac026</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-3416-8210</orcidid><orcidid>https://orcid.org/0000-0003-4805-1037</orcidid><orcidid>https://orcid.org/0000-0001-6852-4220</orcidid><orcidid>https://orcid.org/0000-0002-2973-3369</orcidid><orcidid>https://orcid.org/0000-0002-4155-4451</orcidid></addata></record> |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Heart Failure - epidemiology Heart Valve Prosthesis Implantation - adverse effects Humans Kidney Failure, Chronic - epidemiology Mitral Valve - surgery Mitral Valve Insufficiency - complications Mitral Valve Insufficiency - surgery Treatment Outcome |
| title | Impact of baseline renal dysfunction on cardiac outcomes and end-stage renal disease in heart failure patients with mitral regurgitation: the COAPT trial |
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