Prognostic Value of NT-proBNP in Patients Undergoing Tricuspid Valve Transcatheter Edge-to-Edge Repair: The EuroTR Registry.
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von Stein Jennifer, von Stein Philipp, Kresoja Karl-Patrik, Fortmeier Vera, Pauschinger Christoph, Rottbauer Wolfgang, Kassar Mohammad, Goebel Bjoern, Denti Paolo, Achouh Paul, Rassaf Tienush, Barreiro-Perez Manuel, Boekstegers Peter, Rück Andreas, Zdanyte Monika, Adamo Marianna, Vincent Flavien, Schlegel Philipp, Rosch Sebastian, Wild Mirjam G, Besler Christian, Toggweiler Stefan, Brunner Stephanie, Grapsa Julia, Patterson Tiffany, Thiele Holger, Kister Tobias, Tarantini Giuseppe, Masiero Giulia, De Carlo Marco, Sticchi Alessandro, Voss Fabian, Polzin Amin, Rubbio Antonio P, Bedogni Francesco, Stolte Thorald, Nestelberger Thomas, González Tomás Benito, Sánchez-Muñóz Enrique, Swaans Martin, Timmers Leo, Konstandin Mathias H, Van Belle Eric, Metra Marco, Geisler Tobias, Estévez-Loureiro Rodrigo, Mahabadi Amir Abbas, Karam Nicole, Maisano Francesco, Lauten Philipp, Praz Fabien, Kessler Mirjam, Kalbacher Daniel, Rudolph Volker, Lurz Philipp, Pfister Roman, Cohen David J, Granada Juan F, Hahn Rebecca T, Hausleiter Jörg, Stolz Lukas, Iliadis Christos, EuroTR Investigators
Аннотация
OBJECTIVES: The aim of this study was to evaluate the prognostic value of baseline NT-proBNP and its early postprocedural trajectory after T-TEER.
METHODS: Patients undergoing T-TEER with available baseline NT-proBNP measurements in the EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation) registry were analyzed. NT-proBNP was evaluated continuously and by tertiles, with longitudinal changes assessed when serial measurements were available. Endpoints were the 2-year composite of all-cause mortality or first heart failure hospitalization, changes in NT-proBNP, symptomatic alleviation, and residual TR.
RESULTS: In total, 2,282 patients (median age 80 years [Q1-Q3: 76-83 years], 54% women, 86% in NYHA functional class III or IV) with baseline NT-proBNP values (tertile 1, ≤1,674 pg/mL; tertile 2, 1,674-3,743 pg/mL; and tertile 3, >3,743 pg/mL) were included. Higher tertiles were associated with greater comorbidity burden, more advanced biventricular remodeling, and more severe TR. Baseline NT-proBNP was independently associated with the primary endpoint (adjusted HR: 1.62; 95% CI: 1.29-2.04). Residual TR ≤2+ at discharge occurred in 86.3%, 82.9%, and 81.4% across tertiles (P = 0.040), and higher NT-proBNP was associated with a lower likelihood of symptomatic alleviation (adjusted OR per log10 increase: 0.63; 95% CI: 0.48-0.84; P < 0.001). Both baseline NT-proBNP and higher than expected 30-day levels relative to baseline were independently associated with higher subsequent risk for the primary endpoint.
CONCLUSIONS: Baseline NT-proBNP was independently associated with 2-year mortality or heart failure hospitalization after T-TEER. Early postprocedural NT-proBNP trajectories provided incremental prognostic information and may identify patients at increased risk.