Does a MitraClip procedure cause elevated Brain Natriuretic Peptide (BNP) levels?

Effect of MitraClip Procedure on BNP Levels

Yes, the MitraClip procedure typically causes an initial elevation in BNP levels, but successful treatment leads to significant reduction in BNP/NT-proBNP levels over time in most patients.

Initial BNP Response After MitraClip

The MitraClip procedure has a biphasic effect on BNP levels:

• Immediate post-procedure: BNP levels often increase transiently due to:

  • Procedural stress on the heart
  • Inflammatory response to the intervention
  • Temporary hemodynamic changes during clip placement

• Medium to long-term (3-6 months): In successful cases, BNP levels typically decrease significantly compared to baseline values 1, 2

Evidence for BNP Reduction After MitraClip

Research demonstrates that successful MitraClip placement leads to significant reductions in natriuretic peptide levels:

• A study examining NT-proBNP response after MitraClip showed mean levels decreased from 6,117 pg/mL at baseline to 4,143 pg/mL at 6 months post-procedure (p < 0.001) 1

• Another study demonstrated significant reductions in median NT-proBNP levels from 3,923 pg/mL to 2,636 pg/mL after MitraClip implantation (p = 0.02) 2

• In patients with functional mitral regurgitation, higher preoperative pro-BNP levels (≥1,600 pg/ml) were identified as an independent risk factor for mortality at follow-up 3

Factors Affecting BNP Response After MitraClip

Not all patients show the same degree of BNP reduction after MitraClip. Key factors affecting BNP response include:

• Right ventricular dysfunction: Patients with right ventricular systolic dysfunction (TAPSE <15 mm) are more likely to be NT-proBNP non-responders 1

• Diabetes mellitus: Diabetes is an independent determinant of poor NT-proBNP response after MitraClip 1

• Atrial fibrillation: More common in non-responders to MitraClip therapy 1

• Baseline NT-proBNP levels: Very high baseline levels (>5,000 pg/mL) may predict less robust response 1

Clinical Significance of BNP Changes After MitraClip

The BNP response after MitraClip has important clinical implications:

• A decrease in BNP >30% in response to heart failure treatment generally indicates a good prognosis 4

• NT-proBNP responders (defined as >30% reduction at 6 months) tend to have better clinical outcomes 1

• BNP reduction correlates with:

  • Improved left ventricular remodeling
  • Reduced tricuspid regurgitation pressure gradient
  • Decreased left ventricular end-diastolic volume 2, 5

Monitoring BNP After MitraClip

When interpreting BNP levels after MitraClip:

• Serial measurements are more valuable than single readings 4

• BNP should be interpreted alongside clinical status and echocardiographic findings

• Non-cardiac factors that can affect BNP interpretation include:

  • Renal dysfunction
  • Age
  • Obesity (may lower BNP)
  • Hydration status 4

Clinical Implications

For patients undergoing MitraClip:

• An initial rise in BNP immediately post-procedure should not necessarily be interpreted as treatment failure

• Failure to see BNP reduction by 3-6 months may indicate suboptimal response and should prompt careful clinical reassessment

• Patients with right ventricular dysfunction and diabetes should be monitored more closely as they may have less robust BNP response

• BNP monitoring can help identify patients who may benefit from additional heart failure therapies or consideration for advanced options like heart transplantation 6