Lindenfeld JA, Abraham WT, Grayburn PA, et al. - In the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation (COAPT) trial but not in Multicenter Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients With Severe Secondary Mitral Regurgitation (MITRA-FR), reduced heart failure (HF) hospitalizations (HFHs) and all-cause mortality (ACM) in symptomatic patients with HF and secondary mitral regurgitation (SMR) was observed in correlation with undergoing transcatheter mitral valve repair (TMVr) plus maximally tolerated guideline-directed medical therapy (GDMT) vs GDMT alone. Researchers here examined contributions of the degree of SMR utilizing the effective regurgitation orifice area (EROA), regurgitant volume (RV), and LVEDVi to the advantage of TMVr in the COAPT trial. In this post hoc secondary analysis of the COAPT randomized clinical trial, they evaluated a subgroup of COAPT patients (group 1) with characteristics comparable to patients enrolled in MITRA-FR (n = 56) (HF with grade 3+ to 4+ SMR, left ventricular ejection fraction of 20%-50%, and New York Heart Association function class II-IV) and compared them with remaining (group 2) COAPT patients (n = 492) using the end point of ACM or HFH at 24 months. The ratio of EROA to LVEDV may not be the best factor associated with the benefits of transcatheter mitral valve repair for all-cause mortality or hospitalization for heart failure. No improvement was achieved in ACM or HFH at 24 months in the small subgroup of COAPT-resembling patients enrolled in MITRA-FR however these patients exhibit a significant benefit on patient-centered outcomes (eg, QOL and 6MWD). Per findings, they suggest that ratio of EROA to LVEDV may not represent the best factor linked with the advantages of transcatheter mitral valve repair for all-cause mortality or hospitalization for heart failure.