Objectives

This study sought to understand the extent to which health status and exercise capacity are independently associated with long-term outcomes in patients with heart failure (HF) and secondary mitral regurgitation (MR).

Background

Secondary MR in patients with HF leads to impaired health status (Kansas City Cardiomyopathy Questionnaire Overall Summary Score [KCCQ-OS]) and exercise capacity (6-minute walk distance [6MWD]), both of which improve after transcatheter mitral valve repair (TMVr).

Methods

The study used data from the COAPT trial (N = 604) to examine the association of baseline KCCQ-OS and 6MWD with 2-year mortality and HF hospitalization, adjusting for treatment arm and patient factors. We also examined the association of change in KCCQ-OS and 6MWD from baseline to 1 month with risk of outcomes from 1 month to 2 years. Interactions of KCCQ-OS and 6MWD with treatment assignment were explored.

Results

Mean baseline KCCQ-OS was 53 ± 23 points, and 6MWD was 240 ± 125 meters. In models including both measures, greater baseline 6MWD (but not KCCQ-OS) was associated with reduced 2-year mortality (HR per 125 meters: 0.75, 95% CI: 0.61-0.92). When stratified by treatment group, both baseline KCCQ-OS and 6MWD were independently associated with HF hospitalization in patients treated with medical therapy, whereas only KCCQ-OS was associated with HF hospitalization in patients treated with TMVr. In separate analyses, 1-month improvements in KCCQ-OS and 6MWD were each associated with lower subsequent risk of mortality and HF hospitalization, independent of treatment group.

Conclusions

Among patients with HF and severe secondary MR, assessment of both health status and exercise capacity provide complementary prognostic information for patients with HF and severe secondary MR—both before and after TMVr. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial]; NCT01626079)

中文翻译：

---

心力衰竭和继发性二尖瓣关闭不全中健康状况与功能状态的预后重要性

目标

本研究旨在了解健康状况和运动能力在多大程度上与心力衰竭 (HF) 和继发性二尖瓣关闭不全 (MR) 患者的长期结局独立相关。

背景

HF 患者的继发性 MR 导致健康状况受损（堪萨斯城心肌病问卷总体总结评分 [KCCQ-OS]）和运动能力（6 分钟步行距离 [6MWD]），这两者在经导管二尖瓣修复 (TMVr) 后均得到改善）。

方法

该研究使用来自 COAPT 试验 (N = 604) 的数据来检查基线 KCCQ-OS 和 6MWD 与 2 年死亡率和 HF 住院的关联，并根据治疗组和患者因素进行调整。我们还检查了 KCCQ-OS 和 6MWD 从基线到 1 个月的变化与 1 个月到 2 年的结果风险之间的关联。探讨了 KCCQ-OS 和 6MWD 与治疗分配的相互作用。

结果

平均基线 KCCQ-OS 为 53 ± 23 点，6MWD 为 240 ± 125 米。在包括这两种测量的模型中，更大的基线 6MWD（但不是 KCCQ-OS）与 2 年死亡率降低相关（HR 每 125 米：0.75，95% CI：0.61-0.92）。当按治疗组分层时，基线 KCCQ-OS 和 6MWD 都与接受药物治疗的患者的 HF 住院独立相关，而只有 KCCQ-OS 与接受 TMVr 治疗的患者的 HF 住院相关。在单独的分析中，KCCQ-OS 和 6MWD 的 1 个月改善均与较低的随后死亡和 HF 住院风险相关，与治疗组无关。

结论

在患有 HF 和严重继发性 MR 的患者中，对健康状况和运动能力的评估为患有 HF 和严重继发性 MR 的患者（在 TMVr 之前和之后）提供了补充的预后信息。（MitraClip 经皮治疗功能性二尖瓣关闭不全心力衰竭患者的心血管结果评估 [COAPT 试验]；NCT01626079）