TMVR outcomes suffer when patients have heart failure and diabetes—but benefits remain
Heart failure patients who undergo transcatheter mitral valve repair (TMVR) and have severe secondary mitral regurgitation (SMR) experience worse outcomes if they also present with diabetes, according to new data published in JACC: Heart Failure.
Researchers analyzed data from 614 patients who participated in the COAPT trial. More than 37% of those patients presented with diabetes. All patients underwent TMVR using the MitralClip device.
In the study, diabetic patients had higher two-year rates of mortality compared to those without diabetes. They were also inclined to have elevated rates of heart failure hospitalization (HFH).
The team did note that treating patients with TMVR in addition to guideline-directed medical therapy (GDMT) consistently decreased all-cause mortality and HFH rates in patients with and without diabetes compared to GDMT alone. TMVR also improved the patient's quality of life (QOL), as evaluated by the the Kansas City Cardiomyopathy Questionnaire, and their functional capacity.
"To our knowledge, this is the first study to directly assess the impact of diabetes on the outcome of TMVR with the MitraClip compared with GDMT alone in patients with heart failure and SMR," wrote Bahira Shahim, MD, PhD, a specialist with the Cardiovascular Research Foundation, and colleagues. "We found that, although patients with diabetes had worse outcomes over time than those without diabetes, treatment of severe SMR with TMVR compared to maintenance on GDMT alone reduced the two-year rates of death and HFH, improved QOL and exercise capacity, and improved echocardiographic factors consistently in high-risk heart failure patients both with and without diabetes."
Read the entire study here.