Prognostic Value of NT-proBNP in Patients Undergoing Tricuspid Valve Transcatheter Edge-to-Edge Repair: The EuroTR Registry.

Background N-terminal pro-B-type natriuretic peptide (NT-proBNP) is an established marker of myocardial stress, yet its prognostic role in tricuspid valve transcatheter edge-to-edge repair (T-TEER) for tricuspid regurgitation (TR) remains unclear.Objectives To evaluate the prognostic value of baseline NT-proBNP and its early post-procedural trajectory after T-TEER.Methods Patients undergoing T-TEER with available baseline NT-proBNP measurements in the EuroTR 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 improvement and residual TR.Results 2,282 patients (median age 80 [76-83] years; 54% female; 86% NYHA class III/IV) with baseline NT-proBNP values (T1 ≤1,674 pg/mL, T2 1,674-3,743 pg/mL, and T3 >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 lower likelihood of symptomatic improvement (adjusted OR per log10 increase: 0.58; 95% CI: 0.44-0.75; 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 post-procedural NT-proBNP trajectories provided incremental prognostic information and may identify patients at increased risk.