{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:55:07Z","timestamp":1787018107637,"version":"build-2736575974"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,7,18]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The incidence and implications of worsening renal function (WRF) after mitral valve transcatheter edge\u2010to\u2010edge repair (TEER) in patients with heart failure (HF) are unknown. Therefore, the aim of this study was to determine the proportion of patients with HF and secondary mitral regurgitation who develop persistent WRF within 30\u2009days following TEER, and whether this development portends a worse prognosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial, 614 patients with HF and severe secondary mitral regurgitation were randomized to TEER with the MitraClip plus guideline\u2010directed medical therapy (GDMT) versus GDMT alone. WRF was defined as serum creatinine increase \u22651.5\u00d7 or \u22650.3\u2009mg\/dL from baseline persisting to day 30 or requiring renal replacement therapy. All\u2010cause death and HF hospitalization rates between 30\u2009days and 2\u2009years were compared in patients with and without WRF. WRF at 30\u2009days was present in 11.3% of patients (9.7% in the TEER plus GDMT group and 13.1% in the GDMT alone group;\n                      <jats:italic>P<\/jats:italic>\n                      =0.23). WRF was associated with all\u2010cause death (hazard ratio [HR], 1.98 [95% CI, 1.3\u20133.03];\n                      <jats:italic>P<\/jats:italic>\n                      =0.001) but not HF hospitalization (HR, 1.47 [ 95% CI, 0.97\u20132.24];\n                      <jats:italic>P<\/jats:italic>\n                      =0.07) between 30\u2009days and 2\u2009years. Compared with GDMT alone, TEER reduced both death and HF hospitalization consistently in patients with and without WRF (\n                      <jats:italic>P<\/jats:italic>\n                      <jats:sub>interaction<\/jats:sub>\n                      =0.53 and 0.57, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among patients with HF and severe secondary mitral regurgitation, the incidence of WRF at 30\u2009days was not increased after TEER compared with GDMT alone. WRF was associated with greater 2\u2010year mortality but did not attenuate the treatment benefits of TEER in reducing death and HF hospitalization compared with GDMT alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p xml:lang=\"en\">\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\/jaha.123.029504","type":"journal-article","created":{"date-parts":[[2023,7,8]],"date-time":"2023-07-08T07:33:24Z","timestamp":1688801604000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Incidence, Predictors, and Outcomes Associated With Worsening Renal Function in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial"],"prefix":"10.1161","volume":"12","author":[{"given":"Jeremy","family":"Kong","sequence":"first","affiliation":[{"name":"Kaiser Permanente Department of Cardiology San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan G.","family":"Zaroff","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Department of Cardiology San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4563-1071","authenticated-orcid":false,"given":"Andrew P.","family":"Ambrosy","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Department of Cardiology San Francisco CA USA"},{"name":"Division of Research Kaiser Permanente Northern California Oakland CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1545-6399","authenticated-orcid":false,"given":"Jesse K.","family":"Fitzpatrick","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Department of Cardiology San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivy A.","family":"Ku","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Department of Cardiology San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob M.","family":"Mishell","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Department of Cardiology San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lak N.","family":"Kotinkaduwa","sequence":"additional","affiliation":[{"name":"Clinical Trials Center Cardiovascular Research Foundation New York City 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 City NY USA"},{"name":"NewYork\u2010Presbyterian Hospital\/Columbia University Medical Center New York NY USA"},{"name":"Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirat","family":"Beohar","sequence":"additional","affiliation":[{"name":"Mount Sinai Medical Center Columbia University Division of Cardiology Miami Beach FL 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":"JoAnn","family":"Lindenfeld","sequence":"additional","affiliation":[{"name":"Vanderbilt University Division of Cardiology Nashville TN 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"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3148-9158","authenticated-orcid":false,"given":"Michael J.","family":"Mack","sequence":"additional","affiliation":[{"name":"Baylor Scott and White Healthcare Dallas TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1547-4869","authenticated-orcid":false,"given":"Saibal","family":"Kar","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute Los Robles Health System Thousand Oaks CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. 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