# Preliminary Evaluation of NT-proBNP and cTnI as Predictors of Procedure Safety in Dogs Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair

## TL;DR

This study examines whether NT-proBNP and cTnI levels can predict procedure safety in dogs undergoing a minimally invasive heart repair procedure.

## Contribution

The study is one of the first to evaluate NT-proBNP and cTnI as potential biomarkers for procedure safety in dogs undergoing TEER for MMVD.

## Key findings

- Non-survivors had higher median NT-proBNP and cTnI levels than survivors.
- There was no significant difference in NT-proBNP or cTnI levels between survivors and non-survivors.
- The study suggests that these biomarkers may not be strong predictors of procedure safety in this context.

## Abstract

Transcatheter edge-to-edge mitral valve repair (TEER) is an emerging minimally invasive treatment for dogs with myxomatous mitral valve disease (MMVD). This study evaluated pre-procedure N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) levels to assess their association with procedure safety. Additionally, the relationship between pre-procedure NT-proBNP and cTnI levels and the length of hospitalization was analyzed in the survival group. While the procedure safety supports the application of this technique as a potential therapeutic option in the short term, no comparative observations can be made at this time from the results of this investigation.

Myxomatous mitral valve disease (MMVD) in dogs can be treated with transcatheter edge-to-edge mitral valve repair (TEER), an emerging minimally invasive surgical technique. However, reports on prognostic markers for preoperative evaluation remain limited. This study evaluated the association of preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) levels with procedure safety in dogs undergoing TEER. A retrospective analysis was conducted on 25 dogs diagnosed with stage C (n = 18) or D (n = 7) MMVD that underwent TEER between September 2023 and January 2025. Preoperative NT-proBNP and cTnI values were measured and compared between survivors and non-survivors. Among the survivors, 15 and 4 dogs were stages C and D, respectively. Among the non-survivors, three and three dogs were stages C and D, respectively. Non-survivors had higher median NT-proBNP levels (3557 pmol/L; range: 774–10,000) and cTnI levels (0.39 ng/mL; range: 0.22–0.51) than survivors (NT-proBNP: 1262.6 pmol/L, range: 500–8773; cTnI: 0.1 ng/mL, range: 0.01–3.6). However, the two groups showed no significant differences in NT-proBNP (p = 0.187) or cTnI (p = 0.869). Increased preoperative NT-proBNP and cTnI levels were not strong predictors of procedure safety in dogs with MMVD stages C and D undergoing TEER. Further studies with larger sample sizes and longer follow-up periods are needed to better evaluate the prognostic value of these biomarkers in this population.