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:

New hope for treating heart failure
Heart failure patients who are getting by on existing drug therapies can look forward to a far more effective medicine in the next five years or so, thanks to University of Alberta researchers.
Activated T-cells drive post-heart attack heart failure
Chronic inflammation after a heart attack can promote heart failure and death.
ICU care for COPD, heart failure and heart attack may not be better
Does a stay in the intensive care unit give patients a better chance of surviving a chronic obstructive pulmonary disease (COPD) or heart failure flare-up or even a heart attack, compared with care in another type of hospital unit?
Tissue engineering advance reduces heart failure in model of heart attack
Researchers have grown heart tissue by seeding a mix of human cells onto a 1-micron-resolution scaffold made with a 3-D printer.
Smoking may lead to heart failure by thickening the heart wall
Smokers without obvious signs of heart disease were more likely than nonsmokers and former smokers to have thickened heart walls and reduced heart pumping ability.
After the heart attack: Injectable gels could prevent future heart failure (video)
During a heart attack, clots or narrowed arteries block blood flow, harming or killing cells in the heart.
Heart failure after first heart attack may increase cancer risk
People who develop heart failure after their first heart attack have a greater risk of developing cancer when compared to first-time heart attack survivors without heart failure, according to a study today in the Journal of the American College of Cardiology.
Scientists use 'virtual heart' to model heart failure
A team of researchers have created a detailed computational model of the electrophysiology of congestive heart failure, a leading cause of death.
Increase in biomarker linked with increased risk of heart disease, heart failure, death
In a study published online by JAMA Cardiology, Elizabeth Selvin, Ph.D., M.P.H., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues examined the association of six-year change in high-sensitivity cardiac troponin T with incident coronary heart disease, heart failure and all-cause mortality.
1 in 4 patients develop heart failure within 4 years of first heart attack
One in four patients develop heart failure within four years of a first heart attack, according to a study in nearly 25,000 patients presented today at Heart Failure 2016 and the 3rd World Congress on Acute Heart Failure by Dr.

Related Heart Failure Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Changing The World
What does it take to change the world for the better? This hour, TED speakers explore ideas on activism—what motivates it, why it matters, and how each of us can make a difference. Guests include civil rights activist Ruby Sales, labor leader and civil rights activist Dolores Huerta, author Jeremy Heimans, "craftivist" Sarah Corbett, and designer and futurist Angela Oguntala.
Now Playing: Science for the People

#520 A Closer Look at Objectivism
This week we broach the topic of Objectivism. We'll be speaking with Keith Lockitch, senior fellow at the Ayn Rand Institute, about the philosophy of Objectivism as it's taught through Ayn Rand's writings. Then we'll speak with Denise Cummins, cognitive scientist, author and fellow at the Association for Psychological Science, about the impact of Objectivist ideology on society. Related links: This is what happens when you take Ayn Rand seriously Another Critic Who Doesn’t Care What Rand Thought or Why She Thought It, Only That She’s Wrong Quote is from "A Companion to Ayn Rand"