{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T13:31:05Z","timestamp":1776173465347,"version":"3.50.1"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>In the COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation), treatment of heart failure (HF) patients with moderate-severe or severe secondary mitral regurgitation with transcatheter mitral valve repair (TMVr) using the MitraClip plus guideline-directed medical therapy (GDMT) reduced 2-year rates of HF hospitalization and all-cause mortality compared with GDMT alone. Whether the benefits of the MitraClip extend to patients with previously implanted cardiac resynchronization therapy (CRT) is unknown. We sought to examine the effect of prior CRT in patients enrolled in COAPT.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Patients (N=614) with moderate-severe or severe secondary mitral regurgitation who remained symptomatic despite maximally tolerated doses of GDMT were randomized 1:1 to the MitraClip (TMVr arm) versus GDMT only (control arm). Outcomes were assessed according to prior CRT use.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Among 614 patients, 224 (36.5%) had prior CRT (115 and 109 randomized to TMVr and control, respectively) and 390 (63.5%) had no CRT (187 and 203 randomized to TMVr and control, respectively). Patients with CRT had similar 2-year rates of the composite of death or HF hospitalization compared with those without CRT (57.6% versus 55%,\n              <jats:italic>P<\/jats:italic>\n              =0.32). Death or HF hospitalization at 2 years was lower with TMVr versus control treatment in patients with prior CRT (48.6% versus 67.2%, hazard ratio, 0.60 [95% CI, 0.42\u20130.86]) and without CRT (42.5% versus 66.9%, hazard ratio, 0.52 [95% CI, 0.39\u20130.69]; adjusted\n              <jats:italic>P<\/jats:italic>\n              <jats:sub>interaction<\/jats:sub>\n              =0.23). The effects of TMVr with the MitraClip on reducing the 2-year rates of all-cause death (adjusted\n              <jats:italic>P<\/jats:italic>\n              <jats:sub>interaction<\/jats:sub>\n              =0.14) and HF hospitalization (adjusted\n              <jats:italic>P<\/jats:italic>\n              <jats:sub>interaction<\/jats:sub>\n              =0.82) were also consistent in patients with and without CRT as were improvements in quality-of-life and exercise capacity.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>In the COAPT trial, TMVr with the MitraClip improved the 2-year prognosis of patients with HF and moderate-severe or severe secondary mitral regurgitation who remained symptomatic despite maximally tolerated GDMT, regardless of prior CRT implantation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT01626079.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circheartfailure.120.007293","type":"journal-article","created":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T10:01:33Z","timestamp":1605175293000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":29,"title":["Transcatheter Mitral Valve Repair in Patients With and Without Cardiac Resynchronization Therapy"],"prefix":"10.1161","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct01626079","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Ioanna","family":"Kosmidou","sequence":"first","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (I.K., B.R., B.S., Z.Z., G.W.S.)."},{"name":"NewYork-Presbyterian Hospital\/Columbia University Irving Medical Center (I.K., B.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JoAnn","family":"Lindenfeld","sequence":"additional","affiliation":[{"name":"Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William T.","family":"Abraham","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, The Ohio State University, Columbus (W.T.A., K.D.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saibal","family":"Kar","sequence":"additional","affiliation":[{"name":"Los Robles Regional Medical Center, Thousand Oaks, CA (S.K.)."},{"name":"Bakersfield Heart Hospital, CA (S.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. Scott","family":"Lim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Virginia, Charlottesville (D.S.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob M.","family":"Mishell","sequence":"additional","affiliation":[{"name":"Kaiser Permanente\u2014San Francisco Hospital, CA (J.M.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian K.","family":"Whisenant","sequence":"additional","affiliation":[{"name":"Intermountain Heart Center, Salt Lake City, UT (B.K.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert M.","family":"Kipperman","sequence":"additional","affiliation":[{"name":"Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (R.M.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantinos D.","family":"Boudoulas","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, The Ohio State University, Columbus (W.T.A., K.D.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bj\u00f6rn","family":"Redfors","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (I.K., B.R., B.S., Z.Z., G.W.S.)."},{"name":"NewYork-Presbyterian Hospital\/Columbia University Irving Medical Center (I.K., B.R.)."},{"name":"Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bahira","family":"Shahim","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (I.K., B.R., B.S., Z.Z., G.W.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zixuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (I.K., B.R., B.S., Z.Z., G.W.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Mack","sequence":"additional","affiliation":[{"name":"Baylor Scott and White Health, Plano, TX (M.J.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3416-8210","authenticated-orcid":true,"given":"Gregg W.","family":"Stone","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (I.K., B.R., B.S., Z.Z., G.W.S.)."},{"name":"The Zena and Michael A. 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