Nav: Home

Echocardiograms may help with patient selection for transcatheter mitral valve repair

March 18, 2019

NEW ORLEANS (March 17, 2019) -- Clinicians should use echocardiography, an ultrasound that shows the heart's structure and function, when determining whether patients with heart failure and a leaking heart valve are likely to benefit from valve repair, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.

The new study offers additional insights on the COAPT trial, which investigated the use of a procedure called transcatheter mitral valve repair (TMVR) in patients with secondary mitral regurgitation, a condition where the mitral valve does not close properly due to problems with the heart's pumping chambers. In 2018, COAPT researchers reported that patients undergoing TMVR with the MitraClip device had significantly better rates of survival at two years compared to those receiving standard medications alone.

To help translate COAPT's findings into practical guidance for clinical decisions, the new study details how echocardiography can be used to diagnose secondary mitral regurgitation, along with how the researchers used a multi-parametric algorithm adapted from the American Society of Echocardiography and ACC guidelines to determine which patients were eligible to participate in the study and track the valve's function over the course of two years. While clinicians routinely use echocardiograms when assessing mitral regurgitation, there is no worldwide standard for diagnosing secondary mitral regurgitation with this tool, limiting its application. As a result, details on the study methodology are important for informing clinical practice, researchers said.

"We found echocardiography is valuable for assessing patients with secondary mitral regurgitation on multiple levels," said Federico M. Asch, MD, director of the Echocardiography Core Lab at MedStar Health Research Institute, associate professor of medicine at Georgetown University and the study's lead author. "Echocardiography should be used to determine which patients are candidates for TMVR, and it should also be used after MitraClip implantation to see the results of the procedure."

COAPT enrolled 614 patients treated at 78 medical centers in the U.S. and Canada and randomly assigned them to receive the MitraClip or maximally tolerated medical therapy as recommended by clinical guidelines, which typically includes diuretics, beta blockers and other medications, and sometimes cardiac resynchronization therapy (a pacemaker). All participants had heart failure and moderate to severe secondary mitral regurgitation at the start of the trial. Heart failure is a condition in which the heart is too weak to pump enough blood to meet the body's needs. Secondary mitral valve regurgitation frequently coexists with heart failure, worsens patients' symptoms and affects their quality of life and survival.

Researchers used echocardiography to image participants' hearts before enrollment and during follow-up visits at one, six, 12, 18 and 24 months. They developed an algorithm that was used by expert echocardiographers to interpret the heart images, evaluate the functioning of the valve and determine whether patients were appropriate candidates for the MitraClip procedure. Follow-up assessments revealed that the repaired valve was effective at preventing backward flow of blood through the valve (mitral regurgitation), and that this effect persisted throughout the two years of follow-up.

In addition, the study focused on identifying characteristics of the heart, measurable with an echocardiogram, that may predict which patients would have a better or worse response to TMVR. In this analysis, researchers found that TMVR was equally beneficial across all subgroups analyzed, including the size, function or pressures of the heart's chambers, leading them to conclude that all patients with similar characteristics to those in the trial should be considered for this intervention.

"MitraClip was shown to be beneficial in the study population in all sub-groups analyzed, regardless of patients' echocardiographic characteristics," Asch said. "While we learned that patients with higher pulmonary hypertension are at higher risk after they receive the MitraClip, they still do better than if they would not have had the intervention done. Doing an echocardiogram is critical in determining if a patient is a good candidate for MitraClip and in following these patients to evaluate results of the procedure in the long run."
-end-
The study was funded by Abbott.

The ACC's Annual Scientific Session will take place March 16-18, 2019, in New Orleans, bringing together cardiologists and cardiovascular specialists from around the world to share the newest discoveries in treatment and prevention. Follow @ACCinTouch, @ACCMediaCenter and #ACC19 for the latest news from the meeting.

The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its more than 52,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.

American College of Cardiology

Related Heart Failure Articles:

Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.
Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.
Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.
How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.
Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.
NSAID impairs immune response in heart failure, worsens heart and kidney damage
Non-steroidal anti-inflammatory drugs, or NSAIDs, are widely known as pain-killers and can relieve pain and inflammation.
Heart cell defect identified as possible cause of heart failure in pregnancy
A new Tel Aviv University study reveals that one of the possible primary causes of heart failure in pregnant women is a functional heart cell defect.
In heart failure, a stronger heart could spell worse symptoms
Patients with stronger-pumping hearts have as many physical and cognitive impairments as those with weaker hearts, suggesting the need for better treatment.
Patients with common heart failure more likely to have lethal heart rhythms
New Smidt Heart Institute Research shows that patients with Heart Failure with Preserved Ejection Fraction (HFpEF) are more likely to have lethal heart rhythms.
Why does diabetes cause heart failure?
A Loyola University Chicago Stritch School of Medicine study reveals how, on a cellular level, diabetes can cause heart failure.
More Heart Failure News and Heart Failure Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

In & Out Of Love
We think of love as a mysterious, unknowable force. Something that happens to us. But what if we could control it? This hour, TED speakers on whether we can decide to fall in — and out of — love. Guests include writer Mandy Len Catron, biological anthropologist Helen Fisher, musician Dessa, One Love CEO Katie Hood, and psychologist Guy Winch.
Now Playing: Science for the People

#543 Give a Nerd a Gift
Yup, you guessed it... it's Science for the People's annual holiday episode that helps you figure out what sciency books and gifts to get that special nerd on your list. Or maybe you're looking to build up your reading list for the holiday break and a geeky Christmas sweater to wear to an upcoming party. Returning are pop-science power-readers John Dupuis and Joanne Manaster to dish on the best science books they read this past year. And Rachelle Saunders and Bethany Brookshire squee in delight over some truly delightful science-themed non-book objects for those whose bookshelves are already full. Since...
Now Playing: Radiolab

An Announcement from Radiolab