Biomarkers of systemic disease burden and outcomes after transcatheter tricuspid edge-to-edge repair
TL;DR
Baseline GDF-15 and suPAR were associated with adverse outcomes after T-TEER and demonstrated greater prognostic discrimination than NT-proBNP in this exploratory cohort and support further investigation of systemic stress and inflammation biomarkers for risk stratification in patients with severe tricuspid regurgitation.
Abstract
Risk stratification after transcatheter tricuspid edge-to-edge repair (T-TEER) remains challenging, particularly in patients with advanced right-sided heart failure and systemic disease burden. Biomarkers reflecting inflammation, stress response and multiorgan dysfunction may provide additional prognostic information in this setting. This prospective single-centre cohort study included 84 consecutive patients undergoing T-TEER for severe tricuspid regurgitation using the TriClip or PASCAL system. Baseline concentrations of growth differentiation factor-15 (GDF-15), soluble urokinase plasminogen activator receptor (suPAR), and NT-proBNP were measured prior to intervention. The primary endpoint was all-cause mortality at 12 months. Secondary endpoints included cardiovascular rehospitalisation and a combined cardiovascular endpoint. Prognostic performance was assessed using receiver operating characteristic and tertile-based Kaplan-Meier analyses. Owing to the limited number of events, all analyses were considered exploratory. During 12-month follow-up, all-cause mortality occurred in 10 patients (11.9%), while cardiovascular rehospitalisation was observed in 29 patients (34.5%). GDF-15 demonstrated good discriminative performance for all-cause mortality (AUC 0.823, 95% CI 0.714–0.932, p = 0.001), whereas suPAR showed moderate prognostic discrimination (AUC 0.742, 95% CI 0.605–0.878, p = 0.013). In contrast, NT-proBNP showed no significant discrimination for all-cause mortality (AUC 0.535, 95% CI 0.362–0.709, p = 0.720). Higher tertiles of both GDF-15 and suPAR were associated with reduced overall and rehospitalisation-free survival. Baseline GDF-15 and suPAR were associated with adverse outcomes after T-TEER and demonstrated greater prognostic discrimination than NT-proBNP in this exploratory cohort. These exploratory findings support further investigation of systemic stress and inflammation biomarkers for risk stratification in patients with severe tricuspid regurgitation.