Beyond NT-proBNP: novel biomarkers enhance short- and intermediate-term risk prediction in tricuspid valve interventions

Abstract Background Interventional treatment for tricuspid regurgitation is rapidly evolving, yet optimal patient selection remains a major challenge. Traditional biomarkers like NT-proBNP often fail to accurately reflect disease severity, particularly in patients with cardiorenal syndrome. Emerging biomarkers, such as soluble suppression of tumorigenicity 2 (sST2), soluble urokinase plasminogen activator receptor (suPAR), Heart-Type Fatty Acid-Binding Protein (H-FABP), and Growth Differentiation Factor 15 (GDF-15), offer promising prognostic potential but remain underutilized in clinical practice. This study investigates their predictive value for short-term and intermediate mortality, compared to NT-proBNP. Methods This single-center, prospective cohort study analyzed patients undergoing either edge-to-edge repair, heterotopic minimally invasive tricuspid valve intervention (Tricvalve) or transcatheter tricuspid valve replacement (Evoque). Blood samples were collected pre-procedure, at 3-month follow-up and at 12-month follow-up. NT-proBNP was measured via routine laboratory testing, while GDF-15, H-FABP, suPAR, and sST2 were quantified using commercial ELISA kits. Receiver operator characteristics with calculation of the area under the curve (AUC) were performed to illustrate the predictive value of each biomarker for mortality after 3month and 12 months. We defined an AUC of 0.60-0.69 as poor, 0.70-0.79 as fair, 0.80-0.89 as good, and 0.90-1.00 as excellent in terms of predictive value. Log-rank test was performed, to evaluate survival rates and visualized with Kaplan-Meier curves. Results 62 were included: 49 underwent edge-to-edge repair (TriClip: n=10; Pascal: n=39), 12 received heterotopic tricuspid valve implantation (TricValve: n=12) and 1patient received transcatheter tricuspid valve replacement (Evoque: n=1). Mean age was 80.4 ±7 years, with 51.6% male patients. Within 3 months 11 patients (17.7%) died. Overall mortality after 12 month was 15 (24.2%). At 3-month GDF-15 (AUC 0.77) and suPAR (AUC 0.76), outperformed NT-proBNP (AUC 0.52) which showed no predictive value for mortality. This observation was even more pronounced in the 12-month follow-up: GDF-15 (AUC 0.82); suPAR (AUC 0.83) vs. NT-proBNP (AUC 0.54). The predictive values for biomarkers assessed are shown in Figure 1. b) 3 month and Figure 1. c) 12 months. Conclusion Novel biomarkers, particularly GDF-15 and suPAR, demonstrated superior predictive power for short-term and intermediate mortality following interventional treatment for tricuspid regurgitation. Their integration into clinical risk stratification could enhance patient selection and postoperative monitoring, offering a more precise alternative to NT-proBNP.