Repairing a leaking valve improves the quality of life of patients with heart failure

According to a study presented at the 68th Annual Scientific Session of the American College of Cardiology, patients with heart failure and leaking heart valve reported feeling better and having fewer symptoms of heart failure if they were undergoing a valve repair procedure than patients receiving standard treatment alone.

The results are the latest in the COAPT trial, which investigated the use of a procedure called transcatheter mitral valve repair (TMVR) in patients with secondary mitral regurgitation, a condition in which the mitral valve does not close properly due to heart problems). bedrooms. In 2018, COAPT researchers reported that patients on TMVR had a survival rate significantly greater than two years compared to those receiving standard medical treatment. For this new study, the researchers also badyzed the trial data to determine if valve repair also improved patients' quality of life.

"In patients with heart failure and secondary mitral regurgitation, TMVR has resulted in an early, substantial, and lasting improvement in health status compared to conventional care," said Suzanne Arnold, MD, cardiologist at Mid America Heart Institute of St. Luke, professor of medicine at the University of Missouri – Kansas City and the senior author of the study. "These results are extremely important for patients, demonstrating that TMVR improves patients' symptoms and that their quality of life adds additional support to the use of TMVR in these patients."

Heart failure, an illness in which the heart can not pump enough blood to meet the needs of the body, affects about 5 million people in the United States. It is estimated that at least a quarter of heart failure patients also experience secondary mitral valve regurgitation, allowing blood to flow back through the mitral valve and further reducing the heart's ability to pump blood. People with both of these conditions usually suffer from symptoms such as shortness of breath, swelling and tiredness.

COAPT recruited 614 patients treated at 78 medical centers in the United States and Canada and randomly badigned them to a TMVR or standard medical treatment, which typically includes diuretics, beta-blockers, other drugs and sometimes cardiac resynchronization treatment. All participants had cardiac failure and moderate to severe secondary mitral regurgitation at the start of the trial. The researchers badessed participants' quality of life with the Kansas City Cardiomyopathy Questionnaire (KCCQ), a tool designed to badess the symptoms, functional limitations, social limitations, and quality of life of people with impairments. heart.

At the start of the trial, participants averaged 52 points out of 100 of the KCCQ summary score, reflecting a relatively poor quality of life. Patients' heart failure symptoms significantly limited their daily activities, causing shortness of breath or fatigue when walking on flat ground or doing light housework, Arnold Arnold said.

After one month, TMVR patients reported a 16-point improvement in their average KCCQ score compared to those on standard therapy, which was considered moderate to high. Patients could still experience shortness of breath or fatigue when walking fast or on a slope, but were no longer limited in their ability to do less vigorous activities, such as shopping or walking. at a normal pace.

After two years, patients on TMVR had a mean KCCQ score 13 points higher, on average, than patients on standard therapy.

"The durability of the discovery was a little surprising given that these patients had fairly severe heart failure initially," Arnold said. "You could expect the benefits to decrease over time, and the fact that we have not seen much reduction over time was encouraging."

Although deaths were common in both treatment groups due to their advanced age, comorbidities, and underlying heart failure, a higher proportion of randomized patients for TMVR were alive with significant improvement. health status at each point of follow-up. For example, at age two, 36% of patients treated with TMVR were alive with a moderate improvement in health status compared to only 17% in the standard care group.

The study was limited by the fact that it was not an indiscriminate trial; the patients knew they had undergone valvular repair. In addition, as a relatively large proportion of patients died before the two-year follow-up was completed, the loss of the most seriously ill patients, who likely had the poorest quality of life, may have skewed the average quality of life. time in a slightly upward direction. It is also unclear whether results are generalizable beyond the specific group of patients included in the trial, Arnold said.

More information:
Health status after repair of the transcatheter mitral valve in patients with heart failure and secondary mitral regurgitation: COAPT trial, Suzanne V. Arnold, Khaja M. Chinnakondepalli, John A. Spertus, et al. Journal of the American College of Cardiology, Posted online March 17, 2019

Provided by
American College of Cardiology