Baseline B-Type Natriuretic Peptide and Clinical Outcomes Following Transcatheter Tricuspid Valve Replacement

Transcatheter tricuspid valve replacement (TTVR) has emerged as a nonsurgical approach for patients with severe tricuspid regurgitation. However, clinical variables which may impact the overall patient response to TTVR remain elusive. B-type natriuretic peptide (BNP) may reflect disease severity, which in turn may help predict response to TTVR and identify patients at increased risk of adverse outcomes. We evaluated the association between baseline BNP and clinical outcomes (all-cause hospitalization or death) and Kansas City Cardiomyopathy Questionnaire at 30-days and 1-year among 148 patients undergoing TTVR. BNP was analyzed as both a continuous variable and stratified by tertiles. Baseline BNP tertile was not associated with improvement in health status measured by change in Kansas City Cardiomyopathy Questionnaire score at 30-days (p = 0.48) or 1-year (p = 0.57). Sixteen patients (10.8%) experienced a 30-day event and 34 (23%) experienced a 1-year event. Baseline BNP was higher among patients experiencing 1-year events compared with those without events (median 668 vs 375 pg/ml, p = 0.004). One-year event rates increased stepwise across BNP tertiles (10.2%, 22.5%, and 36.0%; p = 0.0095) at 1-year. In a multivariable Cox regression analysis adjusting for age, body mass index, and serum creatinine, higher baseline BNP was independently associated with the composite endpoint of death or rehospitalization (hazard ratio 1.74, 95% confidence interval 1.15 to 2.64, p = 0.00912). Higher baseline BNP was associated with increased risk of adverse clinical outcomes following TTVR but was not associated with improvement in patient-reported health status. BNP may serve as a marker of disease severity and risk stratification in patients undergoing TTVR.