In a analysis presented at the TVT: The Structural Heart Summit and simultaneously published in the Journal of the American College of Cardiology, researchers shed light on the impact of malnutrition on transcatheter edge-to-edge mitral valve repair (TEER) outcomes.
The study, based on data from the COAPT trial, provides valuable insights into the benefits of this innovative treatment for heart failure patients with severe secondary mitral regurgitation, irrespective of their nutritional status.
The analysis focused on a subgroup of 552 patients from the COAPT trial, with 17% of them classified as malnourished based on a Geriatric Nutritional Risk Index score of 98 or lower. These patients were compared with those without malnutrition. The trial randomly assigned participants to receive medical therapy alone or medical therapy combined with transcatheter edge-to-edge repair using the MitraClip.
Remarkably, the study revealed that transcatheter mitral valve repair offered significant benefits to heart failure patients, even if they had malnutrition. At the 4-year mark, all-cause mortality was higher among patients with malnutrition compared to those without it. However, the assignment to TEER plus guideline-directed medical therapy showed a reduced risk of all-cause mortality when compared to medical therapy alone. These findings underscore the potential life-saving impact of transcatheter mitral valve repair in this patient population.
Reducing Hospitalizations: TEER’s Effect on Heart Failure Hospitalization
While malnutrition at baseline did not impact the risk of heart failure hospitalization at 4 years, the assignment to the TEER group showed a significant reduction in hospitalizations. This suggests that transcatheter edge-to-edge mitral valve repair can effectively lower the risk of heart failure hospitalizations, offering improved quality of life and reducing the burden on healthcare resources.
The study’s findings are significant, as they challenge the notion that malnutrition should be an exclusion criterion for transcatheter edge-to-edge mitral valve repair in heart failure patients with severe secondary mitral regurgitation. The data strongly suggest that malnutrition should not deter patients from potentially life-saving treatment options. Instead, the study authors advocate for performing TEER in appropriate patients meeting COAPT criteria at the earliest possible stage, before severe malnutrition and cardiac cachexia develop.
These findings mark a crucial step forward in addressing a critical knowledge gap and offering hope for heart failure patients with malnutrition.
