https://doi.org/10.1007/s00392-025-02625-4
1Herzzentrum der Universität zu Köln Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland; 2Universitätsklinikum Köln Klinik III für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland; 3Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland
Background: Transcatheter tricuspid valve repair (TTVr) offers a viable alternative for patients with severe tricuspid regurgitation (TR) with high surgical risk. However, predictors of outcomes in these patients remain scarce. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is released by cardiomyocytes in response to ventricular wall stretch and stress, particularly in heart failure (HF). NT-proBNP levels have demonstrated robust prognostic value in numerous patient populations. However, the prognostic utility of NT-proBNP in patients with TR undergoing TTVr has not yet been investigated.
Methods: This single-center, retrospective study included all consecutive patients from 2018 to 2023 who received TTVr through edge-to-edge repair, Cardioband, or TricValve. Patients with missing baseline NT-proBNP measurements at admission or impossible device implantation were excluded. Due to its skewed distribution, NT-proBNP was logarithmized in regression models. Survival analysis was conducted with adjustments for relevant clinical covariates to identify significant predictors of all-cause mortality.
Results: Out of 333 patients undergoing tricuspid valve repair, 317 met eligibility criteria and were followed for a median follow-up of 329 (25th - 75th percentile: 94 - 363) days. The cohort’s median age was 80 years, with 68% female and 85% classified as NYHA class III or IV. TR severity was distributed as follows: 59% with grade III and 41% with grades IV or V according to the Hahn classification. 63% of the patients received an edge-to-edge repair, whereas 32% and 5.0% received a Cardioband and TrcValve procedure respectively. Baseline NT-proBNP had a median value of 2,016 ng/L (1,273 – 3,975 ).The endpoint of all-cause mortality occurred in 57 patients (18%). After adjusting for factors found to be significant in the univariable analysis (dose of loop diuretics at baseline, HF hospitalisations in the past 12 months, NYHA class at baseline, eGFR at baseline and length of hospital stay), the log10 of the NT-proBNP baseline value was significantly associated with all-cause mortality in the multivariable analysis (HR = 2.603, 95% CI: [1.307–5.184], p = 0.007).
Conclusions: Our findings reveal that baseline NT-proBNP levels are independently associated with worse outcomes in patients undergoing TTVr, emphasizing its role as a potential valuable prognostic biomarker in this setting. Routine preoperative NT-proBNP assessment enables the pre-interventional identification of patients at increased risk, facilitating timely intervention planning.