Association of NT-proBNP With Clinical Outcomes in Patients Undergoing Transcatheter Tricuspid Valve Intervention

BACKGROUND: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a well-established biomarker for risk stratification in heart failure. However, its prognostic value and early postprocedural dynamics in patients undergoing transcatheter tricuspid valve intervention (TTVI) remain incompletely defined. OBJECTIVES: The objective of the study was to investigate the association of baseline NT-proBNP levels and early postinterventional NT-proBNP changes with long-term all-cause mortality and symptomatic improvement after TTVI. METHODS: We analyzed a cohort of patients with severe tricuspid regurgitation undergoing TTVI. Patients were stratified according to baseline NT-proBNP tertiles. Changes in NT-proBNP between baseline and 4-week follow-up were assessed, and their association with long-term all-cause mortality was evaluated using Kaplan-Meier analysis and Cox regression. NYHA functional class improvement (≥1 class) at 4 weeks was analyzed as a secondary endpoint using logistic regression. RESULTS: Higher baseline NT-proBNP levels were independently associated with increased long-term all-cause mortality. Early NT-proBNP changes provided additional prognostic information: patients with increasing NT-proBNP levels at 4 weeks showed markedly worse survival, irrespective of procedural success. In contrast, baseline NT-proBNP was not associated with symptomatic improvement according to NYHA functional class at 4-week follow-up. Patients with increasing NT-proBNP levels exhibited larger right atrial volumes and higher right atrial pressures at baseline, suggesting more advanced right-sided remodeling. CONCLUSIONS: In patients undergoing TTVI, baseline NT-proBNP levels and early postprocedural increases in NT-proBNP identify individuals at high risk for long-term mortality but do not predict symptomatic improvement. NT-proBNP reflects residual myocardial stress rather than procedural success and may aid in patient selection and early postinterventional surveillance.