"Integrating Biomarkers and Hemodynamics for 1-Year Mortality Risk Stratification in Transcatheter Tricuspid Intervention"

Background:Transcatheter tricuspid interventions for severe tricuspid regurgitation (TR) are increasingly used, yet many patients present at an advanced stage when clinical benefit is limited.The conventional biomarker 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 TR intervention. Methods:In this prospective single-center cohort, preprocedural blood samples for biomarker assessment (GDF-15, suPAR, H-FABP, 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 allcause mortality was evaluated using receiver operating characteristic analyses.Optimal cut-offs 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 (AUC 0.795, 95% 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 J o u r n a l P r e -p r o o f GDF-15 with RA pressure improved discrimination (AUC 0.805).Elevated GDF-15 or suPAR was associated with significantly reduced survival. Conclusion:In patients undergoing transcatheter tricuspid intervention, GDF-15 and suPAR outperform NT-proBNP for predicting 1-year mortality.Integration of RA pressure further refines risk stratification and may aid patient selection and timing of intervention.