Heart failure biomarker identifies long-term risk in T-TEER patients
Tracking N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements, an established blood biomarker for diagnosing heart failure, may provide significant value when patients undergo tricuspid transcatheter edge-to-edge repair (T-TEER). That’s the primary finding of a new analysis published in JACC: Cardiovascular Interventions.[1]
“Despite the availability of emerging risk scores to support clinical decision-making, outcomes after T-TEER remain heterogeneous,” wrote first author Jennifer von Stein, a cardiac imaging researcher with the University of Cologne and Cardiovascular Research Foundation, and colleagues. “Approximately 20% of patients experience heart failure hospitalizations within the first year, events that are strongly associated with increased mortality and highlight the importance of close post-procedural surveillance.”
Because NT-proBNP measurements are so crucial in the management of heart failure, the group wanted to explore the potential value of using these measurements to help anticipate post-procedural risks in T-TEER patients.
Researchers explored data from more than 2,200 patients who underwent T-TEER for symptomatic tricuspid regurgitation from 2016 to 2024 at one of 30 different European facilities. All patients were treated with transcatheter treatments from Abbott or Edwards Lifesciences. NT-proBNP was measured at baseline and again after 30 days. The median age was 80 years old, and 54% of patients were women. T-TEER successfully reduced tricuspid regurgitation for all patients.
Overall, after a median follow-up period of 1,139 days, the composite endpoint of all-cause mortality or a first heart failure hospitalization occurred in 35.3% of T-TEER patients. Such incidents were found to be more likely in patients with higher NT-proBNP levels. In fact, multiple analyses confirmed that NT-proBNP levels were linked to a patient’s odds of long-term, event-free survival.
Another key takeaway from this study was the fact that increasing NT-proBNP levels over time were linked to a higher risk of all-cause mortality or a first heart failure hospitalization.
“To our knowledge, this is the first and largest study to evaluate both baseline NT-proBNP and its early post-procedural trajectory in patients undergoing T-TEER,” the authors wrote. “We demonstrate that NT-proBNP provides robust prognostic information, complements existing clinical and echocardiographic parameters, and may help identify patients in whom the clinical benefit of T-TEER may be attenuated.”
The group emphasized that clinicians can learn a lot about T-TEER outcomes from reviewing these data. While NT-proBNP levels have long been used to manage heart failure patients, the concept of tracking these measurements to anticipate potential T-TEER complications is relatively new.
“Patients in the highest NT-proBNP tertile exhibited a greater comorbidity burden, worse functional status, a higher clinical risk profile compared with those in lower tertiles, and were less likely to experience symptomatic improvement after T-TEER,” they wrote. “Given that the primary benefit of T-TEER lies in symptomatic relief, these findings may assist clinicians in setting realistic expectations when counseling patients with markedly elevated NT-proBNP levels. Importantly, however, even within this high-risk subgroup, more than half of the patients experienced symptomatic improvement.”
There were certain limitations to the team’s analysis—it was retrospective, for example, and its findings can only be categorized as hypothesis-generating at this time. Even with those things in mind, however, the finding that NT-proBNP levels are an independent predictor of all-cause mortality and heart failure hospitalizations in patients with severe tricuspid regurgitation should help guide future research teams to evaluate this topic in more detail.
“Early post-procedural changes in NT-proBNP offered novel and potentially actionable prognostic signals, warranting further investigation,” the authors concluded. “NT-proBNP thus may serve as a simple and easily accessible biomarker to refine risk stratification, and support patient counseling”
Click here to read the full study in JACC: Cardiovascular Interventions, an American College of Cardiology journal.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.