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. 2025 Jun 18.
doi: 10.1002/ejhf.3725. Online ahead of print.

Prognostic value of NT-proBNP in patients with primary mitral regurgitation undergoing transcatheter edge-to-edge repair

Philipp von Stein  1   2 , Jessica Weimann  3 , Roman Pfister  1 , Sebastian Ludwig  2   3   4 , Benedikt Koell  3   4 , Erwan Donal  5 , Dhairya Patel  6 , Lukas Stolz  7   8 , Tetsu Tanaka  9 , Andrea Scotti  10 , Teresa Trenkwalder  11 , Felix Rudolph  12 , Daryoush Samim  13 , Cristina Giannini  14 , Julien Dreyfus  15 , Jean-Michel Paradis  16 , Marianna Adamo  17 , Nicole Karam  18 , Yohann Bohbot  19 , Anne Bernard  20 , Bruno Melica  21 , Angelo Quagliana  22 , Yoan Lavie Badie  23 , Mirjam Kessler  24 , Omar Chehab  25 , Simon Redwood  25 , Edith Lubos  26 , Lars Sondergaard  22 , Marco Metra  17 , Chiara Primerano  14 , Fabien Praz  13 , Muhammed Gerçek  12 , Erion Xhepa  11 , Georg Nickenig  9 , Azeem Latib  10 , Niklas Schofer  3   4 , Raj Makkar  6 , Juan F Granada  2 , Thomas Modine  27 , Jörg Hausleiter  7   8 , Augustin Coisne  2   28 , Daniel Kalbacher  3   4 , Christos Iliadis  1 ; on behalf of the PRIME‐MR Investigators
Collaborators, Affiliations

Prognostic value of NT-proBNP in patients with primary mitral regurgitation undergoing transcatheter edge-to-edge repair

Philipp von Stein et al. Eur J Heart Fail. .

Abstract

Aims: The prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER) for primary mitral regurgitation (PMR) is unclear. This study assessed the association between NT-proBNP and outcomes and explored its additive value to the Mitral Regurgitation International Database (MIDA) score.

Methods and results: PRIME-MR, a retrospective, international, multicentre registry, includes 3083 consecutive PMR patients treated with M-TEER. This analysis focused on 1382 patients (median age 81 years, 47% female, 82% New York Heart Association [NYHA] functional class III/IV, median EuroSCORE II 4.1%) with available NT-proBNP levels and follow-up. The primary endpoint was death or heart failure hospitalization within 3 years. Median NT-proBNP level was 1991 pg/ml (T1: 578, T3: 6285), and 384 patients reached the primary endpoint (Kaplan-Meier estimate: 48.5%). Log-transformed NT-proBNP levels independently predicted the primary endpoint (adjusted hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.07-1.28; p < 0.001) after adjusting for NYHA class, haemoglobin, creatinine, and atrial fibrillation. In 1041 patients with a modified MIDA score (median 9), the score was initially associated with the primary endpoint (HR 1.10, 95% CI 1.04-1.17; p = 0.002), but lost significance when adjusting for NT-proBNP levels, which remained independently predictive (adjusted HR 1.20, 95% CI 1.07-1.34; p = 0.002).

Conclusions: NT-proBNP, but not the MIDA score, was independently associated with death or heart failure hospitalizations within 3 years in M-TEER-treated PMR patients. Incorporating NT-proBNP levels into clinical assessment may improve risk stratification and potentially supports earlier intervention at lower NT-proBNP levels to optimize outcomes.

Keywords: Mitral valve transcatheter edge‐to‐edge repair; NT‐proBNP; PRIME‐MR; Primary mitral regurgitation.

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