{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T23:37:15Z","timestamp":1787960235091,"version":"build-2784847793"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"17","license":[{"start":{"date-parts":[[2022,2,3]],"date-time":"2022-02-03T00:00:00Z","timestamp":1643846400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Abbott"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Baseline renal dysfunction (RD) adversely impacts outcomes among patients with heart failure (HF) and severe secondary mitral regurgitation (MR). Heart failure and MR, in turn, accelerate progression to end-stage renal disease (ESRD), worsening prognosis. We sought to determine the impact of RD in HF patients with severe MR and the impact of transcatheter mitral valve repair (TMVr) on new-onset ESRD and the need for renal replacement therapy (RRT).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>The COAPT trial randomized 614 patients with HF and severe MR to MitraClip plus guideline-directed medical therapy (GDMT) vs. GDMT alone. Patients were stratified into three RD subgroups based on baseline estimated glomerular filtration rate (eGFR, mL\/min\/1.73\u2005m2): none (\u226560), moderate (30\u201360), and severe (&amp;lt;30). End-stage renal disease was defined as eGFR &amp;lt;15\u2005mL\/min\/1.73\u2005m2 or RRT. The 2-year rates of all-cause death or HF hospitalization (HFH), new-onset ESRD, and RRT according to RD and treatment were assessed. Baseline RD was present in 77.0% of patients, including 23.8% severe RD, 6.0% ESRD, and 5.2% RRT. Worse RD was associated with greater 2-year risk of death or HFH (none 45.3%; moderate 53.9%; severe 69.2%; P &amp;lt; 0.0001). MitraClip vs. GDMT alone improved outcomes regardless of RD (P \u00a0interaction = 0.62) and reduced new-onset ESRD [2.9 vs. 8.1%, hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.15\u20130.76, P = 0.008] and the need for new RRT (2.5 vs. 7.4%, HR 0.33, 95% CI 0.14\u20130.78, P = 0.011).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Baseline RD was common in the HF patients with severe MR enrolled in COAPT and strongly predicted 2-year death and HFH. MitraClip treatment reduced new-onset ESRD and the need for RRT, contributing to the improved prognosis after TMVr.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehac026","type":"journal-article","created":{"date-parts":[[2022,1,14]],"date-time":"2022-01-14T20:12:53Z","timestamp":1642191173000},"page":"1639-1648","source":"Crossref","is-referenced-by-count":36,"title":["Impact of baseline renal dysfunction on cardiac outcomes and end-stage renal disease in heart failure patients with mitral regurgitation: the COAPT trial"],"prefix":"10.1093","volume":"43","author":[{"given":"Nirat","family":"Beohar","sequence":"first","affiliation":[{"name":"Columbia University Medical Center, Columbia University Division of Cardiology at Mount Sinai Medical Center , Miami Beach, FL 33140, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gorav","family":"Ailawadi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University of Michigan , Ann Arbor, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lak N","family":"Kotinkaduwa","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation , New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4155-4451","authenticated-orcid":false,"given":"Bj\u00f6rn","family":"Redfors","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation , New York, NY, USA"},{"name":"NewYork-Presbyterian Hospital\/Columbia University Medical Center , New York, NY, USA"},{"name":"Department of Cardiology, Sahlgrenska University Hospital , Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matheus","family":"Simonato","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation , New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zixuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation , New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loren Garrison","family":"Morgan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Medical University of South Carolina , Columbia, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esteban","family":"Escolar","sequence":"additional","affiliation":[{"name":"Columbia University Medical Center, Columbia University Division of Cardiology at Mount Sinai Medical Center , Miami Beach, FL 33140, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saibal","family":"Kar","sequence":"additional","affiliation":[{"name":"Los Robles Regional Medical Center , Thousand Oaks, CA, USA"},{"name":"Bakersfield Heart Hospital , Bakersfield, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Scott","family":"Lim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Virginia , Charlottesville, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6852-4220","authenticated-orcid":false,"given":"Jacob M","family":"Mishell","sequence":"additional","affiliation":[{"name":"Kaiser Permanente\u2014San Francisco Hospital , San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2973-3369","authenticated-orcid":false,"given":"Brian K","family":"Whisenant","sequence":"additional","affiliation":[{"name":"Intermountain Heart Center , Salt Lake City, UT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4805-1037","authenticated-orcid":false,"given":"William T","family":"Abraham","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, The Ohio State University , Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JoAnn","family":"Lindenfeld","sequence":"additional","affiliation":[{"name":"Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute , Nashville, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J","family":"Mack","sequence":"additional","affiliation":[{"name":"Baylor Scott & White Health , Plano, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3416-8210","authenticated-orcid":false,"given":"Gregg W","family":"Stone","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation , New York, NY, USA"},{"name":"The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai , New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,2,3]]},"reference":[{"key":"2022102517251228300_ehac026-B1","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s11897-013-0164-6","article-title":"Epidemiology and importance of renal dysfunction in heart failure patients","volume":"10","author":"Giamouzis","year":"2013","journal-title":"Curr Heart Fail Rep"},{"key":"2022102517251228300_ehac026-B2","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1093\/eurheartj\/eht515","article-title":"Renal dysfunction and heart failure: things are seldom what they seem","volume":"35","author":"Filippatos","year":"2014","journal-title":"Eur Heart J"},{"key":"2022102517251228300_ehac026-B3","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1093\/eurheartj\/ehv010","article-title":"The kidney in heart failure: an update","volume":"36","author":"Damman","year":"2015","journal-title":"Eur Heart J"},{"key":"2022102517251228300_ehac026-B4","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1093\/eurheartj\/eht386","article-title":"Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis","volume":"35","author":"Damman","year":"2014","journal-title":"Eur Heart J"},{"key":"2022102517251228300_ehac026-B5","doi-asserted-by":"crossref","first-page":"e001349","DOI":"10.1161\/CIRCINTERVENTIONS.113.001349","article-title":"Evaluation of renal function before and after percutaneous mitral valve repair","volume":"8","author":"Wang","year":"2015","journal-title":"Circ Cardiovasc Interv"},{"key":"2022102517251228300_ehac026-B6","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1056\/NEJMoa1009355","article-title":"Percutaneous repair or surgery for mitral regurgitation","volume":"364","author":"Feldman","year":"2011","journal-title":"N Engl J Med"},{"key":"2022102517251228300_ehac026-B7","doi-asserted-by":"crossref","first-page":"2307","DOI":"10.1056\/NEJMoa1806640","article-title":"Transcatheter mitral-valve repair in patients with heart failure","volume":"379","author":"Stone","year":"2018","journal-title":"N Engl J Med"},{"key":"2022102517251228300_ehac026-B8","first-page":"e72","article-title":"2020 ACC\/AHA Guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"2022102517251228300_ehac026-B9","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"Mcdonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"2022102517251228300_ehac026-B10","article-title":"ESC\/EACTS Guidelines for the management of valvular heart disease","author":"Vahanian","journal-title":"Eur Heart J"},{"key":"2022102517251228300_ehac026-B11","doi-asserted-by":"crossref","first-page":"e1649","DOI":"10.4244\/EIJV11I14A316","article-title":"Impact of chronic kidney disease on outcomes after percutaneous mitral valve repair with the MitraClip system: insights from the GRASP registry","volume":"11","author":"Ohno","year":"2016","journal-title":"EuroIntervention"},{"key":"2022102517251228300_ehac026-B12","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/j.jacc.2020.12.047","article-title":"3-Year outcomes of transcatheter mitral valve repair in patients with heart failure","volume":"77","author":"Mack","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2022102517251228300_ehac026-B13","doi-asserted-by":"crossref","first-page":"247","DOI":"10.7326\/0003-4819-145-4-200608150-00004","article-title":"Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate","volume":"145","author":"Levey","year":"2006","journal-title":"Ann Intern Med"},{"key":"2022102517251228300_ehac026-B14","doi-asserted-by":"crossref","first-page":"2307","DOI":"10.1056\/NEJMoa1806640","article-title":"Transcatheter mitral-valve repair in patients with heart failure","volume":"379","author":"Stone","year":"2018","journal-title":"N Engl J Med"},{"key":"2022102517251228300_ehac026-B15","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1016\/j.jacc.2020.07.035","article-title":"Impact of tricuspid regurgitation on clinical outcomes: the COAPT Trial","volume":"76","author":"Hahn","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2022102517251228300_ehac026-B16","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1016\/j.ejheart.2007.05.010","article-title":"Decreased cardiac output, venous congestion and the association with renal impairment in patients with cardiac dysfunction","volume":"9","author":"Damman","year":"2007","journal-title":"Eur J Heart Fail"},{"key":"2022102517251228300_ehac026-B17","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.jacc.2008.05.068","article-title":"Importance of venous congestion for worsening of renal function in advanced decompensated heart failure","volume":"53","author":"Mullens","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"2022102517251228300_ehac026-B18","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/S0735-1097(99)00608-7","article-title":"The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction","volume":"35","author":"Dries","year":"2000","journal-title":"J Am Coll Cardiol"},{"key":"2022102517251228300_ehac026-B19","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1016\/j.kint.2019.06.025","article-title":"Chronic kidney disease and valvular heart disease: conclusions from a kidney disease: improving global outcomes (KDIGO) controversies conference","volume":"96","author":"Marwick","year":"2019","journal-title":"Kidney Int"},{"key":"2022102517251228300_ehac026-B20","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1161\/CIRCULATIONAHA.120.050686","article-title":"Cardiovascular disease in chronic kidney disease: pathophysiological insights and therapeutic options","volume":"143","author":"Jankowski","year":"2021","journal-title":"Circulation"},{"key":"2022102517251228300_ehac026-B21","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1016\/j.kint.2019.02.022","article-title":"Heart failure in chronic kidney disease: conclusions from a kidney disease: improving global outcomes (KDIGO) Controversies Conference","volume":"95","author":"House","year":"2019","journal-title":"Kidney Int"},{"key":"2022102517251228300_ehac026-B22","doi-asserted-by":"crossref","first-page":"2595","DOI":"10.1016\/j.jacc.2020.09.609","article-title":"Pulmonary hypertension in transcatheter mitral valve repair for secondary mitral regurgitation: the COAPT Trial","volume":"76","author":"Ben-Yehuda","year":"2020","journal-title":"J Am Coll Cardiol"}],"container-title":["European Heart Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurheartj\/article-pdf\/43\/17\/1639\/46629757\/ehac026.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurheartj\/article-pdf\/43\/17\/1639\/46629757\/ehac026.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T18:22:22Z","timestamp":1666722142000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurheartj\/article\/43\/17\/1639\/6521532"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,3]]},"references-count":22,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2022,2,3]]},"published-print":{"date-parts":[[2022,5,1]]}},"URL":"https:\/\/doi.org\/10.1093\/eurheartj\/ehac026","relation":{},"ISSN":["0195-668X","1522-9645"],"issn-type":[{"value":"0195-668X","type":"print"},{"value":"1522-9645","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,5,1]]},"published":{"date-parts":[[2022,2,3]]}}}