Moritz Haus, Franziska Grewe, Valeska Bienert, Christian Schach, Andreas Luchner, Christoph Birner, Lars S Maier, Bernhard Unsöld, Michael Paulus, Christine Meindl, Kurt Debl
{"title":"The estimated plasma volume status is an independent predictor for mortality in patients undergoing transcatheter mitral valve repair.","authors":"Moritz Haus, Franziska Grewe, Valeska Bienert, Christian Schach, Andreas Luchner, Christoph Birner, Lars S Maier, Bernhard Unsöld, Michael Paulus, Christine Meindl, Kurt Debl","doi":"10.1007/s00392-026-03021-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Fluid overload and congestion are common in patients with mitral regurgitation and are associated with poor outcome and increased mortality. However, assessment for subclinical congestion in patients undergoing transcatheter edge-to-edge mitral valve repair (M-TEER) remains challenging. Besides the established natriuretic peptides like NT-proBNP, the estimated plasma volume status (ePVS) has emerged as a prognostic marker for intravascular congestion in heart failure and valvular heart disease. This study evaluated the prognostic impact of preprocedural ePVS in patients undergoing M-TEER.</p><p><strong>Methods: </strong>311 patients undergoing M-TEER were prospectively enrolled. The ePVS as the difference between actual and ideal plasma volume was calculated based on Hakim's formula using hematocrit, body weight and sex dependent constants. Follow-up data were collected regularly after M-TEER. Based on 1-year mortality, cut-off values for ePVS and NT-proBNP were calculated.</p><p><strong>Results: </strong>Median ePVS was -3.8% (IQR -10.3% to 3.6%). An elevated ePVS above the cut-off was associated with higher Kaplan-Meier-estimated mortality at 1 year (14.4% vs. 4.7%) and 5 years (63.0% vs. 26.0%; log-rank p<0.001). Elevated ePVS and NTproBNP remained independently associated with mortality after multivariable adjustment (ePVS: HR 2.38, 95%CI 1.20-4.74; p=0.013; NT-proBNP: HR 4.30, 95%CI 1.50-12.31; p=0.007). Their combined assessment provided further risk stratification, with the highest risk in patients with both markers elevated compared with neither (HR 14.27, 95%CI 3.19-63.89; p<0.001).</p><p><strong>Conclusion: </strong>Elevated preprocedural ePVS and NT-proBNP were independent predictors of mortality after M-TEER. Their combined assessment provided further risk stratification and may improve risk assessment in this heterogeneous population.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Research in Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00392-026-03021-2","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Fluid overload and congestion are common in patients with mitral regurgitation and are associated with poor outcome and increased mortality. However, assessment for subclinical congestion in patients undergoing transcatheter edge-to-edge mitral valve repair (M-TEER) remains challenging. Besides the established natriuretic peptides like NT-proBNP, the estimated plasma volume status (ePVS) has emerged as a prognostic marker for intravascular congestion in heart failure and valvular heart disease. This study evaluated the prognostic impact of preprocedural ePVS in patients undergoing M-TEER.
Methods: 311 patients undergoing M-TEER were prospectively enrolled. The ePVS as the difference between actual and ideal plasma volume was calculated based on Hakim's formula using hematocrit, body weight and sex dependent constants. Follow-up data were collected regularly after M-TEER. Based on 1-year mortality, cut-off values for ePVS and NT-proBNP were calculated.
Results: Median ePVS was -3.8% (IQR -10.3% to 3.6%). An elevated ePVS above the cut-off was associated with higher Kaplan-Meier-estimated mortality at 1 year (14.4% vs. 4.7%) and 5 years (63.0% vs. 26.0%; log-rank p<0.001). Elevated ePVS and NTproBNP remained independently associated with mortality after multivariable adjustment (ePVS: HR 2.38, 95%CI 1.20-4.74; p=0.013; NT-proBNP: HR 4.30, 95%CI 1.50-12.31; p=0.007). Their combined assessment provided further risk stratification, with the highest risk in patients with both markers elevated compared with neither (HR 14.27, 95%CI 3.19-63.89; p<0.001).
Conclusion: Elevated preprocedural ePVS and NT-proBNP were independent predictors of mortality after M-TEER. Their combined assessment provided further risk stratification and may improve risk assessment in this heterogeneous population.
导语：液体超载和充血在二尖瓣反流患者中很常见，并与预后不良和死亡率增加有关。然而，评估经导管边缘到边缘二尖瓣修复（M-TEER）患者的亚临床充血仍然具有挑战性。除了已建立的利钠肽如NT-proBNP外，估计血浆容量状态（ePVS）已成为心力衰竭和瓣膜性心脏病血管内充血的预后标志物。本研究评估了术前ePVS对M-TEER患者预后的影响。方法：前瞻性纳入311例M-TEER患者。ePVS作为实际血浆容量与理想血浆容量之间的差异，根据Hakim公式使用红细胞压积、体重和性别依赖常数计算。M-TEER术后定期收集随访数据。根据1年死亡率，计算ePVS和NT-proBNP的临界值。结果：中位ePVS为-3.8% （IQR为-10.3%至3.6%）。高于临界值的ePVS升高与1年（14.4% vs. 4.7%）和5年（63.0% vs. 26.0%） kaplan - meier估计的较高死亡率相关；log-rank p结论：手术前ePVS升高和NT-proBNP是M-TEER术后死亡率的独立预测因子。他们的联合评估提供了进一步的风险分层，并可能改善这一异质人群的风险评估。
期刊介绍：
Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery.
As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
