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Integrating Biomarkers and Hemodynamics for 1-Year Mortality Risk Stratification in Transcatheter Tricuspid
Christoph Edlinger1,2,3, Johannes Schlegl1,2, Marwin Bannehr1,2
1Department of Cardiology, Heart Center Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Bernau/Berlin, Germany.
Background:
Transcatheter tricuspid interventions for severe tricuspid regurgitation are being used increasingly, yet many patients present at an advanced stage, when clinical benefit is limited. The conventional biomarker N-terminal pro-B-type natriuretic peptide (NT-proBNP) often fails to reflect systemic organ injury or right-sided hemodynamics. We hypothesized that systemic biomarkers combined with invasive haemodynamic data improve risk stratification for 1-year mortality after transcatheter tricuspid regurgitation intervention.
Methods:
In this prospective, single-centre cohort, preprocedural blood samples for biomarker assessment (growth differentiation factor-15 [GDF-15], soluble urokinase plasminogen activator receptor [suPAR], heart-type fatty acid-binding protein [H-FABP], soluble suppression of tumorigenicity-2 [sST2}, NT-proBNP) and right atrial (RA) pressure were obtained in patients undergoing transcatheter tricuspid repair or valve implantation. Incremental prognostic value was assessed by adding RA pressure to biomarker-based models. Predictive performance for 1-year all-cause mortality was evaluated using receiver operating characteristic analyses. Optimal cutoffs were derived by Youden's index, and survival was compared using Kaplan-Meier analysis and log-rank testing.
Results:
Among 100 patients (mean age, 80.7 ± 6.7 years; 48% male), 22 (22%) died within 1 year. The cohort showed advanced disease and a high comorbidity burden. GDF-15 demonstrated the highest prognostic accuracy (area under the curve [AUC] 0.795, 95% confidence interval [CI] 0.675-0.915; P < 0.001), followed by suPAR (AUC 0.746, 95% CI 0.626-0.866; P < 0.001). NT-proBNP did not significantly predict mortality. Combining GDF-15 with RA pressure improved discrimination (AUC 0.805). An elevated level of GDF-15 or suPAR was associated with significantly reduced survival.
Conclusions:
In patients undergoing transcatheter tricuspid intervention, GDF-15 and suPAR outperform NT-proBNP in predicting 1-year mortality. Integration of RA pressure further refines risk stratification and may aid patient selection and the timing of intervention.
