System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Randomized Controlled Trial Multicenter Study Ppublish

PubMed: 41771063 DOI: 10.1093/ejhf/xuag007

Mitral regurgitation in patients with heart failure and reduced ejection fraction: insights from GALACTIC-HF.

Eur J Heart Fail 28(4):679-690

Authors: Misato Chimura, Kieran F Docherty, Pardeep S Jhund, Mingming Yang, Ryohei Ono, Alasdair D Henderson, John G F Cleland, Marco Metra, Genzhou Liu, Punag H Divanji, Stephen B Heitner, Stuart Kupfer, Fady I Malik, G Michael Felker, Scott D Solomon, John R Teerlink, John J V McMurray

Affiliations

  • British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK. Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
  • British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
  • British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK. Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
  • Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
  • Cytokinetics, Inc. South San Francisco, CA, USA.
  • Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC, USA.
  • Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
  • Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA.

Abstract

AIMS

Given the emerging role of transcatheter valve repair in HFrEF patients with moderate/severe secondary mitral regurgitation (MR), we evaluated the prevalence and outcomes related to MR in the GALACTIC-HF trial.

METHODS

The randomized GALACTIC-HF trial compared the efficacy and safety of omecamtiv mecarbil to placebo in 8232 patients with HFrEF, with a primary composite outcome of a first HF event or cardiovascular death.

RESULTS

Of 7998 patients (97.2%) with baseline data on MR, 5782 (72.3%) had no MR, 970 (12.1%) had mild MR, and 1221 (15.3%) had moderate MR (only 25 had severe MR). Patients with moderate MR had a higher risk of the primary outcome than those without MR (adjusted HR 1.11; 95% CI 1.01-1.23); risk was not higher in patients with mild MR. The association between moderate MR and the primary outcome was most prominent in patients with less severe HF (milder NYHA class, higher LVEF, and lower N-terminal pro-B-type natriuretic peptide) compared to more severe HF. In adjusted analyses, MR was not associated with mortality, and the results of all analyses remained consistent after including patients with severe MR. The beneficial treatment effect of omecamtiv mecarbil versus placebo on clinical outcomes was not modified by MR. Over 80% of patients with moderate/severe MR fulfilled the broad inclusion criteria for COAPT and RESHAPE-HF2.

CONCLUSIONS

In GALACTIC-HF, almost 15% of patients with heart failure and reduced ejection fraction had moderate MR, which was associated with a higher risk of the primary outcome.

MeSH

Heart Failure, Heart, Heart Failure, Systolic, Mitral Valve Insufficiency