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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median ePVS was -3.8% (IQR -10.3% to 3.6%). An elevated ePVS above the cut-off was associated with higher Kaplan\u2013Meier-estimated mortality at 1 year (14.4% vs. 4.7%) and 5 years (63.0% vs. 26.0%; log-rank\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001). Elevated ePVS and NTproBNP remained independently associated with mortality after multivariable adjustment (ePVS: HR 2.38, 95%CI 1.20-4.74;\n                      <jats:italic>p<\/jats:italic>\n                      =0.013; NT-proBNP: HR 4.30, 95%CI 1.50-12.31;\n                      <jats:italic>p<\/jats:italic>\n                      =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;\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-026-03021-2","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T10:53:43Z","timestamp":1789988023000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The estimated plasma volume status is an independent predictor for mortality in patients undergoing transcatheter mitral valve repair"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2512-7475","authenticated-orcid":false,"given":"Moritz","family":"Haus","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franziska","family":"Grewe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeska","family":"Bienert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Schach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Luchner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Birner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars S.","family":"Maier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Uns\u00f6ld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Paulus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Meindl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt","family":"Debl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"3021_CR1","doi-asserted-by":"publisher","first-page":"686","DOI":"10.1016\/j.jacc.2009.03.077","volume":"54","author":"T Feldman","year":"2009","unstructured":"Feldman T, Kar S, Rinaldi M, Fail P, Hermiller J, Smalling R, Whitlow PL, Gray W, Low R, Herrmann HC, Lim S, Foster E, Glower D (2009) Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort. 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