Prognostic value of NT-proBNP in patients with primary mitral regurgitation undergoing transcatheter edge-to-edge repair - PubMed (original) (raw)
Multicenter Study
. 2025 Dec;27(12):2921-2934.
doi: 10.1002/ejhf.3725. Epub 2025 Jun 18.
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
- PMID: 40533899
- PMCID: PMC12803553
- DOI: 10.1002/ejhf.3725
Multicenter Study
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. 2025 Dec.
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.
© 2025 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Figures
Figure 1
Study flowchart. The PRIME‐MR registry includes a total of 3083 patients. N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) and survival status was available in 1382 patients. Patients were categorized into three groups according to NT‐proBNP tertiles. MR, mitral regurgitation; M‐TEER, mitral valve transcatheter edge‐to‐edge repair.
Figure 2
Kaplan–Meier survival curves for all‐cause mortality or heart failure hospitalization within 3 years stratified by N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) tertiles (T1–T3). Significant differences were observed between T1 versus T2 (p = 0.042), T1 versus T3 (p < 0.001), and T2 versus T3 (p = 0.003).
Figure 3
Kaplan–Meier survival curves for all‐cause mortality (A) and heart failure (HF) hospitalization (B) within 3 years stratified by N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) tertiles (T1–T3). For all‐cause mortality, significant differences were observed between T1 versus T2 (p < 0.001) and T2 versus T3 (p < 0.001), but not for T1 versus T2 (p = 0.120). For HF hospitalizations, a significant difference was observed between T1 versus T3 (p = 0.0046). No significant differences were found between other tertile comparisons: T1 versus T2 (p = 0.19) and T2 versus T3 (p = 0.091).
Figure 4
Unadjusted spline curve depicting the association between pre‐interventional N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) levels and hazard ratio for all‐cause mortality or heart failure hospitalization within 3 years. NT‐proBNP values were logarithmically transformed, with the median set as the reference point (hazard ratio = 1). The risk increases progressively with higher NT‐proBNP levels, as shown by the steep rise in the hazard ratio, particularly at the upper end.
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