von Stein Philipp, Weimann Jessica, Pfister Roman, Ludwig Sebastian, Koell Benedikt, Donal Erwan, Patel Dhairya, Stolz Lukas, Tanaka Tetsu, Scotti Andrea, Trenkwalder Teresa, Rudolph Felix, Samim Daryoush, Giannini Cristina, Dreyfus Julien, Paradis Jean-Michel, Adamo Marianna, Karam Nicole, Bohbot Yohann, Bernard Anne, Melica Bruno, Quagliana Angelo, Badie Yoan Lavie, Kessler Mirjam, Chehab Omar, Redwood Simon, Lubos Edith, Sondergaard Lars, Metra Marco, Primerano Chiara, Praz Fabien, Gerçek Muhammed, Xhepa Erion, Nickenig Georg, Latib Azeem, Schofer Niklas, Makkar Raj, Granada Juan F, Modine Thomas, Hausleiter Jörg, Coisne Augustin, Kalbacher Daniel, Iliadis Christos
Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Cardiovascular Research Foundation, New York, NY, USA.
Eur J Heart Fail. 2025 Jun 18. doi: 10.1002/ejhf.3725.
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.
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).
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.
N端前脑钠肽（NT-proBNP）在接受二尖瓣经导管缘对缘修复术（M-TEER）治疗原发性二尖瓣反流（PMR）患者中的预后价值尚不清楚。本研究评估了NT-proBNP与预后之间的关联，并探讨了其对二尖瓣反流国际数据库（MIDA）评分的附加价值。
PRIME-MR是一项回顾性、国际性、多中心注册研究，纳入了3083例连续接受M-TEER治疗的PMR患者。本分析聚焦于1382例患者（中位年龄81岁，47%为女性，82%为纽约心脏协会[NYHA]功能分级III/IV级，中位欧洲心脏手术风险评估系统II为4.1%），这些患者有可用的NT-proBNP水平及随访数据。主要终点是3年内死亡或因心力衰竭住院。NT-proBNP中位水平为1991 pg/ml（T1：578，T3：6285），384例患者达到主要终点（Kaplan-Meier估计值：48.5%）。在校正NYHA分级、血红蛋白、肌酐和心房颤动后，对数转换后的NT-proBNP水平独立预测主要终点（校正风险比[HR] 1.17，95%置信区间[CI] 1.07 - 1.28；p < 0.001）。在1041例改良MIDA评分（中位值9）的患者中，该评分最初与主要终点相关（HR 1.10，95% CI 1.04 - 1.17；p = 0.002），但在校正NT-proBNP水平后失去显著性，而NT-proBNP水平仍具有独立预测性（校正HR 1.20，95% CI 1.07 - 1.34；p = 0.002）。
在接受M-TEER治疗的PMR患者中，NT-proBNP而非MIDA评分与3年内死亡或因心力衰竭住院独立相关。将NT-proBNP水平纳入临床评估可能改善风险分层，并可能支持在较低NT-proBNP水平时更早进行干预以优化预后。
