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Cunningham J, Zhang L, Claggett B, Abraham W, Jhund P, Kober L, Packer M, Rouleau J, Zile M, Prescott M, Mendelson M, Lefkowitz M, McMurray J, Solomon S, Chutkow W. Aptamer proteomics for biomarker discovery in heart failure with reduced ejection fraction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Though current heart failure (HF) biomarkers are highly prognostic, systematically characterizing associations between circulating proteins and risk of subsequent events may improve clinical risk prediction and illuminate new biological pathways. Large-scale assays measuring thousands of proteins now enable unbiased proteomic investigation in clinical trials.
Purpose
To identify and replicate serum proteins associated with HF events in patients with chronic HF with reduced ejection fraction (HFrEF), and to develop and validate a proteomic risk score.
Methods
Serum levels of 4076 proteins were measured at baseline in the ATMOSPHERE (n=1261, 487 events over 6 years) and PARADIGM-HF (n=1257, 287 events over 4 years) trials of chronic HFrEF using a modified aptamer-based proteomics assay. Proteins associated with the primary endpoint, HF hospitalization or cardiovascular death, were identified in the ATMOSPHERE discovery cohort (false discovery rate<0.05) by Cox regression adjusted for age, sex, treatment arm, and anticoagulant use, and replicated in PARADIGM-HF (Bonferroni-corrected p<0.05). A proteomic risk score was derived in ATMOSPHERE using Cox LASSO penalized regression and evaluated in PARADIGM-HF compared to the MAGGIC clinical risk score and N-terminal pro-B-type natriuretic peptide (NT-proBNP). For proteins associated with the primary endpoint, pathway analysis was conducted using Ingenuity Pathway analysis and an exploratory two-sample Mendelian randomization was performed using genetic and outcome data from both trials and protein quantitative trait loci from deCODE to infer which identified proteins contribute to HF prognosis.
Results
We identified 377 serum proteins associated with the primary endpoint in ATMOSPHERE and replicated 167 in PARADIGM-HF. Prognostic proteins included known HF biomarkers Growth Differentiation Factor 15, NT-proBNP, and Angiopoietin-2, and also a previously unrecognized HF biomarker: Sushi, Von Willebrand Factor Type A, EGF And Pentraxin Domain Containing 1 (SVEP1) (HR 1.60 [95% CI 1.44–1.79] per standard deviation [SD], p=2x10–17) (Table 1). Proteins related to hepatic fibrosis, granulocyte adhesion, and inhibition of matrix metalloproteinases were over-represented. A 64-protein risk score derived in ATMOSPHERE predicted clinical events in PARADIGM-HF with greater discrimination (c-statistic 0.70) than the MAGGIC clinical score (c-statistic 0.61), NT-proBNP (c-statistic 0.65), or both (c-statistic 0.66) (Figure 1). Genetically predicted levels of NT-proBNP, WISP2, FSTL1, and CTSS were associated with the primary endpoint by Mendelian randomization.
Conclusions
We identify SVEP1, an extracellular matrix protein known to cause inflammation in vascular smooth muscle cells, as a previously unrecognized HF biomarker. A 64-protein score improved risk discrimination compared with NT-proBNP and may assist in identifying high-risk patients for clinical trials or disease management programs.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The ATMOSPHERE and PARADIGM-HF trials were sponsored by Novartis
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Affiliation(s)
- J Cunningham
- Brigham and Women's Hospital , Boston , United States of America
| | - L Zhang
- Novartis Institute for Biomedical Research , Cambridge , United States of America
| | - B Claggett
- Brigham and Women's Hospital , Boston , United States of America
| | - W Abraham
- Ohio State University Wexner Medical Center , Columbus , United States of America
| | - P Jhund
- BHF Glasgow Cardiovascular Research Centre , Glasgow , United Kingdom
| | - L Kober
- University of Copenhagen , Copenhagen , Denmark
| | - M Packer
- Baylor University Medical Center , Dallas , United States of America
| | - J Rouleau
- Montreal Heart Institute , Montreal , Canada
| | - M Zile
- Medical University of South Carolina , Charleston , United States of America
| | - M Prescott
- Novartis , East Hanover , United States of America
| | - M Mendelson
- Novartis Institute for Biomedical Research , Cambridge , United States of America
| | - M Lefkowitz
- Novartis , East Hanover , United States of America
| | - J McMurray
- BHF Glasgow Cardiovascular Research Centre , Glasgow , United Kingdom
| | - S Solomon
- Brigham and Women's Hospital , Boston , United States of America
| | - W Chutkow
- Novartis Institute for Biomedical Research , Cambridge , United States of America
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Adamson C, Butt JH, Rouleau J, Abraham W, Desai A, Dickstein K, Kober L, Lefkowitz MP, Packer M, Petrie MC, Swedberg K, Solomon SD, Zile M, Jhund PS, McMurray JJV. Alkaline phosphatase and bilirubin combined are a powerful predictor of outcome in patients with heart failure and reduced ejection fraction: an analysis of the ATMOSPHERE and PARADIGM-HF trials. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Bilirubin is a recognized predictor of adverse outcomes in patients with heart failure and reduced ejection fraction (HFrEF), possibly because it is a marker of congestion. Alkaline phosphatase (ALP) is an enzyme produced in many tissues including the biliary ducts and elevated levels are also associated with congestion.
Purpose
To examine the prognostic value of ALP alone and in combination with bilirubin in patients with HFrEF.
Methods
The study population was ambulatory patients with HFrEF enrolled in 2 recent clinical trials with similar inclusion and exclusion criteria: ATMOSPHERE (derivation cohort) and PARADIGM-HF (validation). Cut points to define elevated bilirubin and alkaline phosphatase were >17mg/dL and >120 U/L respectively. The composite of cardiovascular death or HF hospitalization, its components, and all-cause death related to elevation of one, other or both of bilirubin and ALP was examined using Cox regression. Univariable and multivariable models with adjustment for other recognized prognostic variables including NT-proBNP were analyzed.
Results
Of 7016 patients with HFrEF enrolled in ATMOSPHERE, 6870 had a measurement of both bilirubin and ALP at baseline: mean age 63 years, 22% women, mean LVEF 28% and proportion NYHA class III/IV 37%. Bilirubin and ALP were both normal in 4810 (70.0%) patients, bilirubin was elevated in 1393 (20.3%), ALP was elevated in 360 (5.2%) and both were elevated in 307 (4.5%) patients. Patients with elevation of both ALP and bilirubin were older, had lower systolic blood pressure, higher heart rate, higher NT-pro BNP, more clinical features of congestion, more atrial fibrillation and a greater proportion were treated with diuretics and digoxin. The primary endpoint rates (per 100 person-years) were 10.4 (95% CI 9.9–11.0) when both markers were normal, 15.1 (13.9–16.4) when bilirubin was elevated, 12.4 (10.4–14.9) when alkaline phosphatase was elevated, and 25.6 (22.0–29.9) when both markers were elevated (Figure 1). The adjusted hazard ratios (95% CI) were (both biomarkers normal = reference): elevated bilirubin 1.19 (1.07–1.31), P=0.001; elevated ALP 1.03 (0.84–1.26), P=0.81; both elevated 1.45 (1.21–1.73), P<0.001. Elevation of both bilirubin and ALP was a significant independent predictor of the components of the primary outcome and all-cause death, the corresponding hazard ratios for all cause death were 1.12 (0.99–1.25), p=0.06; 1.19 (0.96–1.47), p=0.12; and 1.51 (1.25–1.82), p<0.001. These findings were validated in PARADIGM-HF (Table 1).
Conclusions
Elevation of ALP in combination with elevated bilirubin identifies a small group of patients at very high risk of adverse outcomes. This may reflect more significant congestion. ALP and bilirubin, inexpensive and routinely measured biochemical tests, are useful prognostic markers in patients with HFrEF.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship.
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Affiliation(s)
- C Adamson
- University of Glasgow , Glasgow , United Kingdom
| | - J H Butt
- University of Glasgow , Glasgow , United Kingdom
| | - J Rouleau
- University of Montreal , Montreal , Canada
| | - W Abraham
- Ohio State University Hospital , Ohio , United States of America
| | - A Desai
- Brigham and Women's Hospital , Boston , United States of America
| | - K Dickstein
- Medical University of South Carolina , Charleston , United States of America
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | | | - M Packer
- Baylor University Medical Center , Dallas , United States of America
| | - M C Petrie
- University of Glasgow , Glasgow , United Kingdom
| | - K Swedberg
- University of Gothenburg , Gothenburg , Sweden
| | - S D Solomon
- Brigham and Women's Hospital , Boston , United States of America
| | - M Zile
- Medical University of South Carolina , Charleston , United States of America
| | - P S Jhund
- University of Glasgow , Glasgow , United Kingdom
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Scotti A, Coisne A, Granada J, Asch F, Driggin E, Zhou Z, Kar S, Lim S, Cohen D, Lindenfeld J, Abraham W, Mack M, Stone G. TCT-338 Malnutrition in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Bohra C, Asch F, Lerakis S, Little S, Redfors B, Li Y, Weissman N, Grayburn P, Kar S, Lim S, Abraham W, Lindenfeld J, Mack M, Stone G. TCT-334 Pulmonary Venous Flow Pattern as a Predictor of Outcomes in Patients With Secondary Mitral Regurgitation: The COAPT Trial. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Shahim B, Cohen D, Asch F, Bax J, George I, Rück A, Ben-Yehuda O, Kar S, Lim S, Saxon J, Zhou Z, Lindenfeld J, Abraham W, Mack M, Stone G. TCT-337 Repeat Mitral Valve Interventions After Transcatheter Edge-to-Edge Repair in Heart Failure: The COAPT Trial. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Adamson C, Abraham W, Desai A, Dickstein K, Kober L, McMurray JJ, Packer M, Rouleau J, Solomon S, Zile M, Jhund PS. Patterns Of Recurrent Heart Failure Hospitalizations In Relation To Cardiovascular Death In Heart Failure With Reduced Ejection Fraction. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lehenbauer K, Asch F, Weissman NJ, Grayburn P, Kar S, Lim S, Li D, Puri R, Kapadia S, Sannino A, Lindenfeld J, Abraham W, Mack MJ, Stone GW, Hahn R. Impact of changes in tricuspid regurgitation on clinical outcomes following mitral valve teer compared to guideline-directed medical therapy: a sub-analysis of the COAPT trial. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT)
Background
Prior studies suggest tricuspid regurgitation (TR) diminishes/resolves following mitral valve surgery and thus do not require treatment and may not influence outcomes.
Purpose
We sought to evaluate the change in TR (ΔTR) and its association with outcomes after transcatheter edge-to-edge repair (TEER) compared with guideline-directed medical therapy (GDMT) in the COAPT trial.
Methods
Patients from the COAPT trial with echo core lab TR assessment at baseline and 30-day follow-up (n = 504) were included and divided into 2 groups: those whose TR worsened (ΔTR-INC) and those with no change or improvement in TR (ΔTR-SAME/DEC). Two-year composite endpoints of death or heart failure hospitalization (HFH) and the individual components were analyzed, after excluding events occurring within the first 30 days.
Results
ΔTR-SAME/DEC occurred in 430 pts (228 TEER, 202 GDMT) while ΔTR-INC was noted in 74 pts (38 TEER, 36 GDMT) (Figure 1A). From 30 days to 2 years, ΔTR-INC pts had a higher rate of the composite outcome of death or HFH compared with ΔTR-SAME/DEC (p = 0.006, Figure 1B). Both 2-year death (HR 1.52, 95% CI 1.01-2.27; p = 0.04) and HFH (HR 1.52, 95% CI 1.04-2.22; p = 0.03) were associated with ΔTR-INC. Assessed by treatment group (Figure 1C and 1D), the relationship between ΔTR-INC and composite death or HFH was significant in GDMT alone pts (HR 1.86, 95% CI 1.21-2.86) but not in TEER pts (HR 1.33, 95% CI 0.79-2.23), although interaction testing demonstrated consistency between the two treatments (Pint = 0.31).
Conclusions
Worsening TR at 30 days occurred in ∼15% of pts in the COAPT trial whether they were treated with TEER or GDMT alone. DTRINC was associated with increased death and HFH during 2-year follow-up. Abstract Figure 1
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Affiliation(s)
- K Lehenbauer
- Columbia University Medical Center, New York, United States of America
| | - F Asch
- Medstar Research Institute, Washington, DC, United States of America
| | - NJ Weissman
- Medstar Research Institute, Washington, DC, United States of America
| | - P Grayburn
- Baylor Scott & White Health, Plano, United States of America
| | - S Kar
- Los Robles Health System, Los Angeles, United States of America
| | - S Lim
- University of Virginia, Charlottesville, United States of America
| | - D Li
- Cardiovascular Research Foundation, New York, United States of America
| | - R Puri
- Cleveland Clinic, Cleveland, United States of America
| | - S Kapadia
- Cleveland Clinic, Cleveland, United States of America
| | - A Sannino
- Baylor Scott & White Health, Plano, United States of America
| | - J Lindenfeld
- Vanderbilt University Medical Center, Nashville, United States of America
| | - W Abraham
- Ohio State University Wexner Medical Center, Columbus, United States of America
| | - MJ Mack
- Baylor Scott & White Health, Plano, United States of America
| | - GW Stone
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Hahn
- Columbia University Medical Center, New York, United States of America
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Cohen DJ, Wang K, Magnuson E, Smith R, Petrie MC, Buch MH, Abraham W, Lindenfeld J, Mack MJ, Stone GW, Cleland JGF. Cost-effectiveness of transcatheter edge-to-edge repair in secondary mitral regurgitation. Heart 2022; 108:717-724. [PMID: 35078867 PMCID: PMC8995818 DOI: 10.1136/heartjnl-2021-320005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/28/2021] [Indexed: 11/04/2022]
Abstract
BackgroundTranscatheter edge-to-edge mitral valve repair (TMVr) improves symptoms and survival for patients with heart failure with reduced left ventricular ejection fraction (HFrEF) and severe secondary mitral regurgitation despite guideline-recommended medical therapy (GRMT). Whether TMVr is cost-effective from a UK National Health Service (NHS) perspective is unknown.MethodsWe used patient-level data from the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial to perform a cost-effectiveness analysis of TMVr +GRMT versus GRMT alone from an NHS perspective. Costs for the TMVr procedure were based on standard English tariffs and device costs. Subsequent costs were estimated based on data acquired during the trial. Health utilities were estimated using the Short-Form 6-Dimension Health Survey.ResultsCosts for the index procedural hospitalisation were £18 781, of which £16 218 were for the TMVr device. Over 2-year follow-up, TMVr reduced subsequent costs compared with GRMT (£10 944 vs £14 932, p=0.006), driven mainly by reductions in heart failure hospitalisations; nonetheless, total 2-year costs remained higher with TMVr (£29 165 vs £14 932, p<0.001). When survival, health utilities and costs were projected over a lifetime, TMVr was projected to increase life expectancy by 1.57 years and quality-adjusted life expectancy by 1.12 quality-adjusted life-years (QALYs) at an incremental cost of £21 980, resulting in an incremental cost-effectiveness ratio (ICER) of £23 270 per QALY gained (after discounting). If the benefits of TMVr observed in the first 2 years were maintained without attenuation, the ICER improved to £12 494 per QALY.ConclusionsFor patients with HFrEF and severe secondary mitral regurgitation similar to those enrolled in COAPT, TMVr increases life expectancy and quality-adjusted life expectancy compared with GRMT at an ICER that represents good value from an NHS perspective.
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Affiliation(s)
- David J Cohen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Kaijun Wang
- Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Elizabeth Magnuson
- Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Robert Smith
- Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Mark C Petrie
- University of Glasgow Institute of Cardiovascular and Medical Sciences, Glasgow, UK
- Golden Jubilee National Hospital, Clydebank, UK
| | - Mamta Heena Buch
- Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - William Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Michael J Mack
- Baylor Scott & White The Heart Hospital Plano, Plano, Texas, USA
| | - Gregg W Stone
- The Zena & Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - John G F Cleland
- University of Glasgow Robertson Centre for Biostatistics, Glasgow, UK
- National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College London, London, UK
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Cavalcante J, Asch F, Garcia S, Weissman N, Sorajja P, Medvedofsky D, Zhou Z, Alu M, Hahn R, Lindenfeld J, Abraham W, Redfors B, Mack M, Stone G. TCT-378 Functional Mitral Regurgitation Staging and Its Relationship to Outcomes in the COAPT Trial. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pio SM, Medvedofsky D, Delgado V, Namazi F, Weissman N, Grayburn P, Kar S, Lim S, Zhou Z, Liu M, Alu M, Redfors B, Kapadia S, Lindenfeld J, Abraham W, Mack M, Asch F, Stone G, Bax J. TCT-2 Changes in Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT trial. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Perl L, Meerkin D, D’Amario D, Ben Avraham B, Hasin T, Ince H, Feickert S, Schaefer U, Sievert H, Leyva F, Whinnett Z, Di Mario C, Jonas M, Caspi O, Koren O, Abraham W, Kornowski R, Crea F. TCT-130 Initial Results From the VECTOR-HF Trial—A System for Remote Left Atrial Pressure Monitoring for Patients With Heart Failure. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vincent F, Kosmidou I, Redfors B, Li D, Kar S, Lim S, Mishell J, Whisenant B, Lindenfeld J, Abraham W, Mack M, Stone G. TCT-293 Bleeding Complications of Transcatheter Edge-To-Edge Repair: Analysis From the COAPT Trial. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zeitler EP, O'Connor CM, Abraham W, Lindenfeld J. How Is Medical Device Innovation Currently Supported in the U.S.?: From the Heart Failure Collaboratory. JACC Heart Fail 2021; 9:855-857. [PMID: 34711350 DOI: 10.1016/j.jchf.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Brener MI, Grayburn P, Lindenfeld J, Burkhoff D, Liu M, Zhou Z, Alu MC, Medvedofsky DA, Asch FM, Weissman NJ, Bax J, Abraham W, Mack MJ, Stone GW, Hahn RT. Right Ventricular-Pulmonary Arterial Coupling in Patients With HF Secondary MR: Analysis From the COAPT Trial. JACC Cardiovasc Interv 2021; 14:2231-2242. [PMID: 34674862 DOI: 10.1016/j.jcin.2021.07.047] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to determine the prognostic impact of right ventricular (RV)-pulmonary arterial (PA) coupling in patients with heart failure (HF) with severe secondary mitral regurgitation (SMR) enrolled in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial. BACKGROUND RV contractile function and PA pressures influence outcomes in patients with SMR, but the impact of RV-PA coupling in patients randomized to transcatheter edge-to-edge repair (TEER) vs guideline-directed medical therapy (GDMT) is unknown. METHODS RV-PA coupling was assessed by the ratio of RV free wall longitudinal strain derived from speckle-tracking echocardiography and noninvasively measured RV systolic pressure. Advanced RV-PA uncoupling was defined as RV free wall longitudinal strain/RV systolic pressure ≤0.5%/mm Hg. The primary endpoint was a composite of all-cause mortality or HF hospitalization at 24-month follow-up. RESULTS A total of 372 patients underwent speckle-tracking echocardiography, and 70.2% had advanced RV-PA uncoupling. By multivariable analysis, advanced RV-PA uncoupling was strongly associated with an increased risk for the primary 24-month endpoint of death or HF hospitalization (HR: 1.87; 95% CI: 1.31-2.66; P = 0.0005). A similar association was present for all-cause mortality alone (HR: 2.57; 95% CI: 1.54-4.29; P = 0.0003). The impact of RV-PA uncoupling was consistent in patients randomized to TEER and GDMT alone. Compared with GDMT alone, the addition of TEER improved 2-year outcomes in patients with (48.0% vs 74.8%; HR: 0.51; 95% CI: 0.37-0.71) and those without (28.8% vs 47.8%; HR: 0.51; 95% CI: 0.27-0.97) advanced RV-PA uncoupling (Pinteraction = 0.98). CONCLUSIONS In the COAPT trial, advanced RV dysfunction assessed by RV-PA uncoupling was a powerful predictor of 2-year adverse outcomes in patients with HF and SMR. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial]; NCT01626079).
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Affiliation(s)
- Michael I Brener
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Paul Grayburn
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel Burkhoff
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Mengdan Liu
- Cardiovascular Research Foundation, New York, New York, USA
| | - Zhipeng Zhou
- Cardiovascular Research Foundation, New York, New York, USA
| | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York, USA
| | - Diego A Medvedofsky
- Cardiovascular Core Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Federico M Asch
- Cardiovascular Core Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Neil J Weissman
- Cardiovascular Core Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Jeroen Bax
- Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - William Abraham
- Davis Heart and Lung Research Institute, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Michael J Mack
- Baylor Scott & White Heart and Vascular Hospital, Plano, Texas, USA
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA.
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Lerakis S, Kini A, Asch FM, Kar S, Lim D, Mishell J, Whisenant B, Grayburn P, Weissman N, Rinaldi M, Sharma S, Kapadia SR, Rajagopal V, Sarembock I, Brieke A, Tang G, Li D, Crowley A, Lindenfeld J, Abraham W, Mack MJ, Stone G. Outcomes of transcatheter mitral valve repair for secondary mitral regurgitation by severity of left ventricular dysfunction. EUROINTERVENTION 2021; 17:e335-e342. [PMID: 33589408 PMCID: PMC9724994 DOI: 10.4244/eij-d-20-01265] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In the COAPT trial, transcatheter mitral valve repair with the MitraClip plus maximally tolerated guideline-directed medical therapy (GDMT) improved clinical outcomes compared with GDMT alone in symptomatic patients with heart failure (HF) and 3+ or 4+ secondary mitral regurgitation (SMR) due to left ventricular (LV) dysfunction. AIMS In this COAPT substudy, we sought to evaluate two-year outcomes in HF patients with reduced LV ejection fraction (HFrEF; LVEF ≤40%) versus preserved LVEF (HFpEF; LVEF >40%) and in those with severe (LVEF ≤30%) versus moderate (LVEF >30%) LV dysfunction. METHODS The principal effectiveness outcome was the two-year rate of death from any cause or HF hospitalisations (HFH). Subgroup analysis with interaction testing was performed according to baseline LVEF; 472 patients (82.1%) had HFrEF (mean LVEF 28.0%±6.2%; range 12% to 40%) and 103 (17.9%) had HFpEF (mean LVEF 46.6%±4.9%; range 41% to 65%), while 292 (50.7%) had severely depressed LVEF (LVEF ≤30%; mean LVEF 23.9%±3.8%) and 283 (49.3%) had moderately depressed LVEF (LVEF >30%; mean LVEF 39.0%±6.8%). RESULTS The two-year rate of death or HFH was 56.7% in patients with HFrEF and 53.4% with HFpEF (HR 1.16, 95% CI: 0.86-1.57, p=0.32). MitraClip reduced the two-year rate of death or HFH in patients with HFrEF (HR 0.50, 95% CI: 0.39-0.65) and HFpEF (HR 0.60, 95% CI: 0.35-1.05), pint=0.55. MitraClip was consistently effective in reducing the individual endpoints of mortality and HFH, improving MR severity, quality of life, and six-minute walk distance in patients with HFrEF, HFpEF, LVEF ≤30%, and LVEF >30%. CONCLUSIONS In the COAPT trial, among patients with HF and 3+ or 4+ SMR who remained symptomatic despite maximally tolerated GDMT, the MitraClip was consistently effective in improving survival and health status in patients with severe and moderate LV dysfunction and those with preserved LVEF.
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Affiliation(s)
- Stamatios Lerakis
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Federico M. Asch
- MedStar Health Research Institute, Washington, DC, USA,Georgetown University, Washington, DC, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, CA, USA,Bakersfield Heart Hospital, Bakersfield, CA, USA
| | - D. Lim
- Division of Cardiology, University of Virginia, Charlottesville, VA, USA
| | - Jacob Mishell
- Kaiser Permanente - San Francisco Hospital, San Francisco, CA, USA
| | | | - Paul Grayburn
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX, USA
| | - Neil Weissman
- MedStar Health Research Institute, Washington, DC, USA,Georgetown University, Washington, DC, USA
| | - Michael Rinaldi
- Sanger Heart & Vascular Institute/Atrium Health, Charlotte, NC, USA
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - Gilbert Tang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ditian Li
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Aaron Crowley
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Joanne Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, TN, USA
| | - William Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Gregg Stone
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, 1 Gustave L. Levy Place, New York, NY 10029, USA
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Brener M, Grayburn P, Lindenfeld J, Burkhoff D, Liu M, Asch F, Medvedofsky D, Weissman N, Bax J, Abraham W, Mack M, Stone G, Hahn R. TCT CONNECT-350 Impact of Right Ventricular-Pulmonary Arterial Coupling in Heart Failure Patients With Functional Mitral Regurgitation: Analysis From the COAPT Trial. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kosmidou I, Lindenfeld J, Abraham W, Rinaldi M, Kapadia S, Rajagopal V, Brieke A, Rogers J, Shahim B, Redfors B, Zhang Z, Mack M, Stone G. TCT CONNECT-344 Transcatheter Mitral Valve Repair or Medical Therapy for Severe Functional Mitral Regurgitation in Women Compared With Men: The COAPT Trial. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Arnold S, Stone G, Jain S, Mack M, Saxon J, Ambrosy A, Malik U, Ku I, Mishell J, Zhang Z, Lindenfeld J, Abraham W, Cohen D. TCT CONNECT-354 Prognostic Importance of Functional Status Versus Health Status in Patients With Heart Failure and Severe Secondary Mitral Regurgitation. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ben-Yehuda O, Shahim B, Chen S, Liu M, Redfors B, Hahn RT, Asch FM, Weissman NJ, Medvedofsky D, Puri R, Kapadia SR, Sannino A, Grayburn PA, Kar S, Kar, Lim S, Lindenfeld J, Abraham W, Mack M, Stone GW. IMPACT OF PULMONARY HYPERTENSION IN PATIENTS UNDERGOING TRANSCATHETER MITRAL VALVE REPAIR FOR SECONDARY MITRAL REGURGITATION: THE COAPT TRIAL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31837-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Lerakis S, Kini AS, Kar S, Kar, Lim S, Mishell JM, Whisenant B, Rinaldi M, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Weissman NJ, Asch FM, Grayburn PA, Tang G, Crowley A, Sharma SK, Lindenfeld J, Abraham W, Mack M, Stone GW. OUTCOMES OF TRANSCATHETER MITRAL VALVE REPAIR IN PATIENTS WITH SECONDARY MITRAL REGURGITATION ACCORDING TO THE SEVERITY OF LEFT VENTRICULAR DYSFUNCTION: THE COAPT TRIAL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31742-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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21
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Brinkley DM, Guglin M, Bennett M, Redfield MM, Abraham W, Brett ME, Dirckx N, Adamson PB, Stevenson L. PULMONARY ARTERY PRESSURE MONITORING EFFECTIVELY GUIDES MANAGEMENT TO REDUCE HEART FAILURE HOSPITALIZATIONS IN PATIENTS WITH OBESITY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31282-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Arnold SV, Stone GW, Mack M, Chhatriwalla A, Austin B, Zhang Z, Ben-Yehuda O, Kar S, Kar, Lim S, Lindenfeld J, Abraham W, Cohen DJ. ASSOCIATION BETWEEN SHORT-TERM HEALTH STATUS CHANGES AND LONG-TERM CLINICAL OUTCOMES AFTER TRANSCATHETER MITRAL VALVE REPAIR VS. MEDICAL THERAPY IN PATIENTS WITH HEART FAILURE AND FUNCTIONAL MITRAL REGURGITATION: THE COAPT TRIAL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31727-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Hahn R, Asch FM, Weissman NJ, Grayburn PA, Kar S, Kar, Lim S, Ben-Yehuda O, Shahim B, Chen S, Liu M, Redfors B, Medvedofsky D, Puri R, Kapadia S, Sannino A, Lindenfeld J, Abraham W, Mack M, Stone G. IMPACT OF TRICUSPID REGURGITATION ON OUTCOMES AFTER MITRACLIP TREATMENT OF SECONDARY MITRAL REGURGITATION: RESULTS FROM THE COAPT TRIAL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31726-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abraham W, Augostini R, Hasan A, Jackson S, Kahwash R, Mease J, Sitaramesh E. Treatment of Central Sleep Apnea in Heart Failure Patients. Heart Lung 2020. [DOI: 10.1016/j.hrtlng.2020.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Lerakis S, Kini AS, Asch FM, Weissman NJ, Grayburn PA, Kar S, Kar, Lim S, Mishell JM, Whisenant B, Rinaldi M, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Tang G, Crowley A, Sharma SK, Lindenfeld J, Abraham W, Mack M, Stone GW. DO EARLY CHANGES IN LEFT VENTRICULAR EJECTION FRACTION PREDICT LONG-TERM OUTCOMES AFTER TRANSCATHETER MITRAL VALVE REPAIR OF SECONDARY MITRAL REGURGITATION? THE COAPT TRIAL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31931-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gertz Z, Herrmann H, Lim S, Kar S, Kar, Kapadia SR, Reed GW, Puri R, Krishnaswamy A, Gersh BJ, Weissman NJ, Asch FM, Kosmidou I, Zhang Z, Abraham W, Lindenfeld J, Stone GW, Mack M. IMPACT OF A HISTORY OF ATRIAL FIBRILLATION ON THE MECHANISM OF MITRAL REGURGITATION, PROGNOSIS AND TREATMENT EFFECTS OF THE MITRACLIP: THE COAPT TRIAL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31798-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ailawadi G, Lim S, Kar S, Kar, Mishell JM, Whisenant B, Grayburn PA, Rinaldi M, Ben-Yehuda O, Shahim B, Redfors B, Beohar N, Zhang Z, Lindenfeld J, Abraham W, Mack M, Stone GW. IMPACT OF RENAL DYSFUNCTION ON OUTCOMES IN PATIENTS WITH SECONDARY MITRAL REGURGITATION: RESULTS FROM THE COAPT TRIAL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31847-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Halaby R, Herrmann H, Lim S, Kar S, Kar, Lindenfeld J, Abraham W, Grayburn PA, Asch FM, Weissman NJ, Zhang Y, Mack M, Stone G. LACK OF ASSOCIATION OF MITRAL VALVE GRADIENT AFTER MITRACLIP WITH OUTCOMES IN FUNCTIONAL MITRAL REGURGITATION: RESULTS FROM THE COAPT TRIAL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31936-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kosmidou I, Lindenfeld J, Abraham W, Kar S, Kar, Lim S, Mishell JM, Whisenant B, Kipperman RM, Boudoulas K, Zhang Y, Zhang Z, Mack M, Stone GW. CLINICAL OUTCOMES FOLLOWING TRANSCATHETER MITRAL VALVE REPAIR VERSUS MEDICAL THERAPY FOR SECONDARY MITRAL REGURGITATION IN PATIENTS WITH PREVIOUSLY IMPLANTED CARDIAC RESYNCHRONIZATION THERAPY: THE COAPT TRIAL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31738-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abraham W, Lindenfeld J, Mack M, Ellis J, Morishetti D, Weissman N, Stone G. 1386Reduction of mitral regurgitation in patients with heart failure and secondary mitral regurgitation: relationship between changes in brain natriuretic peptide and outcomes from the COAPT trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Brain natriuretic peptide (BNP) is a well-established predictor of hospitalization and death in patients with heart failure (HF). In the COAPT trial, treatment of patients with HF and secondary mitral regurgitation (SMR) with transcatheter mitral valve repair (TMVr) reduced the 2-year rates of all-cause mortality and HF hospitalization compared with maximally-tolerated guideline-directed medical therapy (GDMT) alone. Whether these improvements in outcomes were reflected in serial changes in BNP levels has not been reported.
Purpose
Herein, we report the first results of serial changes in BNP levels by treatment group in patients from the COAPT trial.
Methods
614 patients with HF and 3+ or 4+ SMR were randomized 1:1 to TMVr + GDMT or GDMT alone. Key inclusion criteria included NYHA functional class II-IVa (ambulatory), ischemic or non-ischemic cardiomyopathy with LVEF 20%-50% and LVESD ≤70 mm. Baseline BNP or NT-proBNP levels were drawn at baseline and at 6 and 12 months. For the present analysis NT-proBNP (pg/ml) values were converted to BNP values (pg/ml) using a ratio of 7 to 1.
Results
At baseline, mean values of BNP were not significantly different between treatment groups (945 pg/ml vs. 964 pg/ml in the TMVr + GDMT and GDMT groups respectively, p=0.84). At 6 months, mean values of BNP in the TMVr + GDMT group were significantly lower than in the GDMT alone group (690 pg/ml vs 893 pg/ml, p=0.02) but not at 12 months (584 pg/ml vs. 728 pg/ml, p=0.22). By analysis of covariance, BNP decreased to a greater degree after TMVr + GDMT compared with GDMT only at both 6 and 12 months (least squares mean differences of −121 pg/ml and −166 pg/ml respectively, both p<0.05) (Figure).
Change in BNP level from baseline
Conclusions
In patients with HF and 3+ or 4+ SMR enrolled in the COAPT trial, reduction of SMR with TMVr reduced BNP compared with maximally-tolerated GDMT only, a change which paralleled the reductions noted in all-cause mortality and HF hospitalizations with TMVr.
Acknowledgement/Funding
Abbott
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Affiliation(s)
- W Abraham
- The Ohio State University, Departments of Medicine, Physiology, and Cell Biology, and the Davis Heart & Lung Institute, Columbus, United States of America
| | - J Lindenfeld
- Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville, United States of America
| | - M Mack
- Heart Hospital Baylor Plano, Baylor HealthCare System, Dallas, United States of America
| | - J Ellis
- Abbott, Santa Clara, United States of America
| | | | - N Weissman
- MedStar Health Research Institute, Hyattsville, United States of America
| | - G Stone
- New York Presbyterian Hospital, Columbia University Medical Center, and The Cardiovascular Research, New York, United States of America
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Fiuzat M, Sbolli M, Cani DS, O'Connor C, Abraham W, Psotka M, Januzzi J. Guideline Directed Medical Therapy in Heart Failure Trials: A New Proposed Scoring System. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Guha A, Dey AK, Armanious M, Dodd K, Bonsu J, Jneid H, Abraham W, Fradley MG, Addison D. Health care utilization and mortality associated with heart failure-related admissions among cancer patients. ESC Heart Fail 2019; 6:733-746. [PMID: 31264809 PMCID: PMC6676288 DOI: 10.1002/ehf2.12450] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/20/2019] [Accepted: 04/21/2019] [Indexed: 12/13/2022] Open
Abstract
AIMS Heart failure (HF) outcomes continue to improve with widespread use of new therapies. Concurrently, cancer survival has dramatically improved. Yet whether cancer patients share similar strategies and outcomes of inpatient HF treatment to those without HF is unknown. We sought to assess the contemporary impacts of cancer on inpatient HF outcomes over time. METHODS AND RESULTS The retrospective National Inpatient Sample (2003-15) and National Readmissions Database (2013-14) registries were queried for adults admitted for HF and stratified for cancer status, excluding cases of metastatic disease. Temporal trends in HF admissions, hospital charge rates, length of hospitalization, HF-related procedure utilization, in-hospital mortality, and hospital readmissions were analysed. Over 13 years of follow-up, there were 12 769 077 HF admissions (mean age 73 years, 50.8% female, 30.8% non-White), among which 1 413 287 (11%) had a co-morbid cancer diagnosis. Cancer patients were older, were predominantly male, and tended to be smokers. Over time, HF admission rates among cancer patients increased, despite a concurrent decrease among patients without cancer (P < 0.0001). After propensity matching, in-hospital mortality was significantly higher among cancer HF patients (5.1% vs. 2.9%, P < 0.0001). Additionally, HF-related procedure utilization was disproportionately lower among cancer patients (0.30 vs. 0.35 procedures/HF hospitalization, P < 0.001); the presence of cancer was associated with increased costs, length of hospitalizations, and all-cause readmissions, but fewer HF readmissions (P < 0.0001, each). CONCLUSIONS While the incidence of HF hospitalizations has increased among cancer patients, they do not appear to share the same rates of advanced HF care, readmissions trends, or reductions in in-hospital mortality. Future studies targeting modifiable factors related to these differences are needed.
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Affiliation(s)
- Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA.,Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Amit Kumar Dey
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Merna Armanious
- Cardio-Oncology Program, Division of Cardiovascular Medicine, University of South Florida Morsani College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Katherine Dodd
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA
| | - Janice Bonsu
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA
| | - Hani Jneid
- Division of Cardiology, Michael E. DeBakey VA Hospital, Baylor College of Medicine, Houston, TX, USA
| | - William Abraham
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA
| | - Michael G Fradley
- Cardio-Oncology Program, Division of Cardiovascular Medicine, University of South Florida Morsani College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA.,Cancer Control Program, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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Johnston P, Duckers E, Raval A, Cook T, Traverse J, Abraham W, Altman P, Pepine C. TCT-747 The CardiAMP Heart Failure Study: First Results from Unblinded Roll-In Phase. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Perl L, Soifer E, Bartunek J, Erdheim D, Abraham W, Meerkin D. TCT-478 In Vivo Performance of a Novel Permanently Implanted Left Atrial Pressure Monitoring System. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Duckers E, Raval A, Pepine C, Johnston P, Traverse J, Emery J, Miller L, Abraham W, Altman P. TCT-748 Performance of Helix transendocardial biotherapeutic delivery system after 300 cases. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Costanzo MR, Goldberg LR, Ponikowski P, Augostini R, Stellbrink C, Abraham W. Phrenic Nerve Simulation for Central Sleep Apnea is Effective and Safe in the Presence of Concomitant Cardiac Devices. J Card Fail 2018. [DOI: 10.1016/j.cardfail.2018.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Breathett K, Maffett S, Foraker R, Sturdivant R, Moon K, Hasan A, Franco V, Smith S, Lampert B, Emani S, Haas G, Kahwash R, Hershberger R, Binkley P, Helmkamp L, Colborn K, Peterson P, Sweitzer N, Abraham W. Pilot Randomized Controlled Trial to Reduce Readmission for Heart Failure Using Novel Tablet and Nurse Practitioner Education. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abraham W, Vahanian A, Alfieri O, Colombo A, Kuck KH, Baldus S, Maisano F, Hausleiter J, Kerner A, Tamburino C, van der Heyden J, von Bardeleben RS, Nickenig G. Transcatheter Mitral Valve Repair in Patients with Functional Mitral Regurgitation—One-Year Outcomes From the Multicenter CE Trial. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sager P, Darpo B, Midei M, Camm A, O'Grady P, Druzgala P, Abraham W. P3012Perhexiline inhibits multiple cardiac ion channels and prolongs the QTc interval predominantly by lengthening the Tpeak-Tend interval. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Raval NY, Shavelle D, Bourge RC, Costanzo MR, Shlofmitz R, Heywood JT, Adamson P, Desai A, Rathman LD, Abraham W, Stevenson LW. Significant Reductions in Heart Failure Hospitalizations with the Pulmonary Artery Pressure Guided HF System: Preliminary Observations From the CardioMEMS Post Approval Study. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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42
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Stone G, Abraham W, Lindenfeld J, Weissman N, Marx S, Ellis J, Crosson LA, Mack M. TCT-627 Cardiovascular Outcomes Assessment of MitraClip Therapy in Heart Failure Patients with Functional Mitral Regurgitation (The COAPT Trial): Baseline Characteristics and Preliminary 30-Day and 1-Year Outcomes of the Roll-In Cohort. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.769] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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43
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Salathe M, Baumlin N, Kis A, Krick S, Schmid A, Sabater J, Abraham W. WS03.4 Angiotensin receptor blockers reverse cystic fibrosis (CF)-related mucociliary dysfunction in vitro and in a novel CF sheep model in vivo. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30075-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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44
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Desai AS, Adamson P, Stevenson L, Henderson J, Ginn G, Bauman J, Abraham W. CHANGES IN PULMONARY ARTERY PRESSURE OVER TIME PREDICT RISK OF HEART FAILURE HOSPITALIZATION. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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45
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Del Trigo M, Bergeron S, Bernier M, Amat-Santos IJ, Campelo-Parada F, Altisent OAJ, Pibarot P, Eigler N, Litvack F, Katzenellenbogen R, Rosen L, Rozenfeld E, Abraham W, Rodes-Cabau J. TCT-33 Left Atrial Decompression with the V-Wave Shunt Device for the Treatment of Heart Failure: Preliminary Safety and Efficacy Results. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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46
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47
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Ponikowski P, Krueger S, Oldenburg O, Germany R, Abraham W. Prevalence of Central Sleep Apnea in Patients Screened During the remedē® System Pilot Study. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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48
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Adamson PB, Abraham W, Stevenson L, Neville S, Cowart P, Yadav J. BENEFITS OF PULMONARY ARTERY PRESSURE MONITORING EXTEND TO REDUCTION OF ALL-CAUSE REHOSPITALIZATION. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60746-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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49
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Raina A, Bourge R, Abraham W, Adamson P, Bauman J, Yadav J, Benza R. Use of a Wireless Implantable Hemodynamic Monitor Leads to Reductions in Heart Failure Hospitalizations Among WHO Group II Pulmonary Hypertension Patients. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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50
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Ponikowski P, Ponikowski P, Jagielski D, Oldenburg O, Augostini R, Krueger S, Kolodziej A, Gutleben KJ, Khayat R, Merliss A, Javaheri S, Abraham W. TCT-134 Transvenous Phrenic Nerve Stimulation in the Treatment of Central Sleep Apnea in Patients with Reduced Ejection Fraction: A Report from the remede(r) System Pilot Study. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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