Biomarkers of systemic disease burden and outcomes after transcatheter tricuspid edge-to-edge repair

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Severe tricuspid regurgitation (n=84). Intervention: Baseline GDF-15 and suPAR concentrations vs. Lower baseline concentrations. Primary outcome: All-cause mortality at 12 months (AUC 0.823, 95% CI 0.714-0.932, p=0.001).

Q: What does this research mean for the field?

Elevated baseline GDF-15 and suPAR levels provide prognostic discrimination for 12-month mortality and adverse outcomes following transcatheter tricuspid edge-to-edge repair, outperforming NT-proBNP. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Johannes Schlegl; Marwin Bannehr; Michael Lichtenauer; Tanja Kücken; Alexander Krutz; Vera Paar; Michael Neuß; Anja Haase-Fielitz; Christian Butter; Christoph Edlinger

doi:10.1186/s12872-026-06392-6

August 3, 2026BMC Cardiovascular DisordersOpen Access

Biomarkers of systemic disease burden and outcomes after transcatheter tricuspid edge-to-edge repair

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Key result

Elevated baseline GDF-15 predicts 12-month mortality after tricuspid TEER with an AUC of ~0.82.

AUC 0.823
95% CI 0.714-0.932
P=0.001
n=84

Figures

Why the study?

Risk stratification after T-TEER remains challenging in patients with advanced right-sided heart failure and systemic disease burden, where biomarkers reflecting inflammation, stress response, and multiorgan dysfunction may provide prognostic value.

Key Points

To assess whether circulating biomarkers of systemic stress and multiorgan dysfunction (GDF-15 and suPAR) provide prognostic value for adverse outcomes in patients undergoing transcatheter tricuspid edge-to-edge repair.
Conducted a prospective single-centre cohort study including N=84 consecutive patients undergoing T-TEER for severe tricuspid regurgitation with TriClip (16.7%) or PASCAL (83.3%).
Measured pre-interventional baseline concentrations of GDF-15, suPAR, and NT-proBNP.
Tracked the primary endpoint of all-cause mortality and secondary cardiovascular endpoints at 12 months using receiver operating characteristic and tertile-based Kaplan-Meier analyses.
At 12-month follow-up, all-cause mortality occurred in 10 of 84 patients (11.9%) and cardiovascular rehospitalisation in 29 of 84 patients (34.5%).
Baseline GDF-15 showed good discrimination for 12-month all-cause mortality (AUC 0.823, 95% CI 0.714–0.932, p = 0.001) and suPAR showed moderate discrimination (AUC 0.742, 95% CI 0.605–0.878, p = 0.013), while NT-proBNP demonstrated no significant discrimination (AUC 0.535, 95% CI 0.362–0.709, p = 0.720).
Stratification by baseline tertiles revealed significantly worse 12-month overall survival for higher tertiles of GDF-15 (log-rank χ² = 9.203, p = 0.010) and suPAR (log-rank χ² = 8.620, p = 0.013), alongside reduced rehospitalisation-free survival.

Study Design

Type

Cohort (n=84)

Multicenter

No

Structured PICO

P

Population

84 patients with symptomatic severe tricuspid regurgitation undergoing transcatheter edge-to-edge repair, followed for 12 months.

E

Exposure

Transcatheter tricuspid edge-to-edge repair (T-TEER) using either the TriClip system or the PASCAL system, with baseline measurement of growth differentiation factor-15 (GDF-15), soluble urokinase plasminogen activator receptor (suPAR), and NT-proBNP.

O

Outcome

All-cause mortality at 12 monthshard clinical

Main Result

Effect estimate: AUC 0.823 (95% CI 0.714-0.932)

p-value: p=0.001

Limitations

Single-centre observational study with a relatively small sample size
Relatively low number of clinical events limited statistical power
Biomarker measurements were performed only at baseline prior to the intervention
Echocardiographic follow-up was incomplete at 12 months
Predominance of the PASCAL system compared with the TriClip system precluded meaningful device-specific analyses
Residual confounding due to unmeasured variables cannot be excluded
Limited number of events precluding extensive multivariable modelling
Single-centre design
No independent core laboratory for echocardiography

Implication

In patients undergoing transcatheter tricuspid edge-to-edge repair, baseline GDF-15 and suPAR levels provided better prognostic discrimination for 12-month mortality and cardiovascular rehospitalization than NT-proBNP.

Abstract

Background 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. Methods 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. Results 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. Conclusion 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.

Discussion

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Cite This Study

Schlegl et al. (2026) conducted a cohort in Severe tricuspid regurgitation (n=84). Baseline GDF-15 and suPAR concentrations vs. Lower baseline concentrations was evaluated on All-cause mortality at 12 months (AUC 0.823, 95% CI 0.714-0.932, p=0.001). Elevated baseline GDF-15 concentrations demonstrated good prognostic discrimination for 12-month all-cause mortality (AUC 0.823) in patients undergoing transcatheter tricuspid edge-to-edge repair.

synapsesocial.com/papers/6a72e7e2226790f3706573d1 https://doi.org/10.1186/s12872-026-06392-6

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Biomarkers of systemic disease burden and outcomes after transcatheter tricuspid edge-to-edge repair

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Biomarkers of systemic disease burden and outcomes after transcatheter tricuspid edge-to-edge repair

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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