MP25. Impact and Risk Predictors of proBNP Levels On Long-Term Outcomes After Transcatheter Edge-To-Edge Repair for Mitral Valve Regurgitation
Presented During: Moderated E-Posters
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I did my medical school in Firenze, Italy.
I did My residency in Siena, Italy.
I did a three year clinical fellowship in Toronto, Canada.
I did a PhD at CARIM Maastricht University.
I am an Associate Professor at Lankenau Institute for Medical Research.
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
OBJECTIVE: To identify risk predictors that interact with prohormone B-type natriuretic peptide (proBNP), and analyze their impact on long-term outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) for mitral valve regurgitation (MR).
METHODS: All consecutive patients undergoing TEER between March 2017 and October 2021 were included in the study. Patients with proBNP ≤ 500 and ˃ 500 were compared for baseline demographics. A propensity-adjusted analysis was used to compare the two groups. Primary outcome was long-term incidence of all-cause death and major adverse cardiovascular and cerebrovascular events (MACCE). A Multivariable Cox proportional hazards regression analysis was performed to identify independent predictors for long-term all-cause mortality.
RESULTS: A total of 171 patients who underwent TEER were included in the study. After propensity-adjusted analysis, 90 patients were included in the proBNP ≤ 500 (low) cohort and 76 patients in the proBNP ˃ 500 cohort. Preoperatively, mean age was 79.4 vs 78.4-year-old in the low proBNP and high proBNP cohorts, respectively. Cardiogenic shock incidence was 3 (3.33%) vs 8 (10.53%) in the low and high proBNP cohorts, respectively. Intraoperatively there were no differences. Postoperatively there was a higher incidence of total ICU length of stay in the high proBNP vs low proBNP cohort (54.5 vs 18.6 hours, respectively; p˂0.0001), total LOS (6.45 vs 2.7 days, respectively; p=0.003), creatinine level (1.7 vs 1.2, respectively; p=0.0001), and warfarin use upon hospital discharge (19 (25%) vs 8 (8.9%) patients, respectively; p=0.022). Mean follow-up time was 2.2 years. All-cause death (HR 1.9 [1,2; 3,0]; p=0.009), MACCE (HR 1,8 [1,2; 2,8]; p=0.006), and cardiac mortality (HR 2,2 [1,1;4,4]; p=0.026) were higher in the proBNP ˃ 500 compared to the proBNP ≤ 500 proBNP cohort. Cardiac readmission included 30 (33.3%) patients in the low proBNP cohort and 29 (38%) patients in the high proBNP cohort. Risk predictors for all-cause mortality were pre-operative grade of MR, EF ˂50%, functional MR, and NYHA class IV.
CONCLUSIONS
Patients with a proBNP level ˃ 500 had a higher incidence of all-cause mortality, MACCE and cardiac mortality when compared to patients with a proBNP ≤ 500. Risk predictors for all-cause mortality included functional MR etiology. The study outcomes suggest that prior optimization of proBNP levels in TEER by the heart-team is crucial for good outcomes.
METHODS: All consecutive patients undergoing TEER between March 2017 and October 2021 were included in the study. Patients with proBNP ≤ 500 and ˃ 500 were compared for baseline demographics. A propensity-adjusted analysis was used to compare the two groups. Primary outcome was long-term incidence of all-cause death and major adverse cardiovascular and cerebrovascular events (MACCE). A Multivariable Cox proportional hazards regression analysis was performed to identify independent predictors for long-term all-cause mortality.
RESULTS: A total of 171 patients who underwent TEER were included in the study. After propensity-adjusted analysis, 90 patients were included in the proBNP ≤ 500 (low) cohort and 76 patients in the proBNP ˃ 500 cohort. Preoperatively, mean age was 79.4 vs 78.4-year-old in the low proBNP and high proBNP cohorts, respectively. Cardiogenic shock incidence was 3 (3.33%) vs 8 (10.53%) in the low and high proBNP cohorts, respectively. Intraoperatively there were no differences. Postoperatively there was a higher incidence of total ICU length of stay in the high proBNP vs low proBNP cohort (54.5 vs 18.6 hours, respectively; p˂0.0001), total LOS (6.45 vs 2.7 days, respectively; p=0.003), creatinine level (1.7 vs 1.2, respectively; p=0.0001), and warfarin use upon hospital discharge (19 (25%) vs 8 (8.9%) patients, respectively; p=0.022). Mean follow-up time was 2.2 years. All-cause death (HR 1.9 [1,2; 3,0]; p=0.009), MACCE (HR 1,8 [1,2; 2,8]; p=0.006), and cardiac mortality (HR 2,2 [1,1;4,4]; p=0.026) were higher in the proBNP ˃ 500 compared to the proBNP ≤ 500 proBNP cohort. Cardiac readmission included 30 (33.3%) patients in the low proBNP cohort and 29 (38%) patients in the high proBNP cohort. Risk predictors for all-cause mortality were pre-operative grade of MR, EF ˂50%, functional MR, and NYHA class IV.
CONCLUSIONS
Patients with a proBNP level ˃ 500 had a higher incidence of all-cause mortality, MACCE and cardiac mortality when compared to patients with a proBNP ≤ 500. Risk predictors for all-cause mortality included functional MR etiology. The study outcomes suggest that prior optimization of proBNP levels in TEER by the heart-team is crucial for good outcomes.