Next-generation biomarkers for short term risk stratification in tricuspid valve intervention

Interventional therapies for tricuspid regurgitation are rapidly evolving, yet optimal patient selection remains challenging. Conventional biomarkers such as NT-proBNP may inadequately reflect the complex pathophysiology and clinical risk in this population. Emerging biomarkers-including soluble suppression of tumorigenicity 2 (sST2), soluble urokinase-type plasminogen activator receptor (suPAR), heart-type fatty acid-binding protein (H-FABP), and growth differentiation factor-15 (GDF-15)-remain insufficiently studied in patients undergoing transcatheter tricuspid valve interventions.

This prospective, single-center observational cohort study enrolled consecutive patients undergoing transcatheter treatment for severe tricuspid regurgitation, including transcatheter edge-to-edge repair and heterotopic caval valve implantation. Pre-procedural blood samples were collected and analyzed for GDF-15, suPAR, H-FABP, and sST2 using standardized assays. Prognostic performance for the composite endpoint of all-cause mortality or heart-failure rehospitalization within three months was assessed using receiver-operating-characteristic analysis and multivariable Cox regression.

Sixty patients (mean age 80.3 ± 7.3 years; 48.3% male) were included. At three months, 12 patients (20%) were rehospitalized and 6 (10%) had died. GDF-15 (AUC 0.867) and suPAR (AUC 0.885) demonstrated strong predictive accuracy and outperformed NT-proBNP. GDF-15 >1,400 pg/mL independently predicted adverse outcomes (HR 2.03, p = 0.046).

GDF-15 and suPAR provide incremental prognostic value for short-term risk stratification after transcatheter tricuspid valve intervention.